Provider Demographics
NPI:1821621491
Name:KLEIN, KENNETH (R PH)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:KLEIN
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15626 WELDON DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77032-2078
Mailing Address - Country:US
Mailing Address - Phone:713-502-6916
Mailing Address - Fax:
Practice Address - Street 1:814 HONEA EGYPT RD STE 106
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3864
Practice Address - Country:US
Practice Address - Phone:281-789-4525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist