Provider Demographics
NPI:1821355397
Name:KLEIN, MATTHEW P
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:P
Last Name:KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 NE MERMAN DR
Mailing Address - Street 2:APT. D202
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5084
Mailing Address - Country:US
Mailing Address - Phone:360-852-4741
Mailing Address - Fax:
Practice Address - Street 1:1890 NE MERMAN DR
Practice Address - Street 2:APT. D202
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5084
Practice Address - Country:US
Practice Address - Phone:360-852-4741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIR60151565183500000X
IDE14846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist