Provider Demographics
NPI:1861033276
Name:KLEINSCHMIDT, NINA MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:MARIE
Last Name:KLEINSCHMIDT
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:M
Other - Last Name:AREVALO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1315 MINNESOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:56501-3913
Mailing Address - Country:US
Mailing Address - Phone:415-596-1283
Mailing Address - Fax:
Practice Address - Street 1:1315 MINNESOTA AVE
Practice Address - Street 2:
Practice Address - City:DETROIT LAKES
Practice Address - State:MN
Practice Address - Zip Code:56501-3913
Practice Address - Country:US
Practice Address - Phone:415-596-1283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy