Provider Demographics
NPI:1710196142
Name:KLINCK-STAHL, THERESE DIANE (RPH)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:DIANE
Last Name:KLINCK-STAHL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 BRIARCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1059
Mailing Address - Country:US
Mailing Address - Phone:716-833-9603
Mailing Address - Fax:
Practice Address - Street 1:20 LAWRENCE BELL DR.
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221
Practice Address - Country:US
Practice Address - Phone:716-204-9060
Practice Address - Fax:716-204-9250
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0394521835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric