Provider Demographics
NPI:1912221441
Name:KLEMM, RANDALL (RPH)
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:KLEMM
Suffix:
Gender:M
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:PO BOX 2767
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97402-0308
Mailing Address - Country:US
Mailing Address - Phone:541-744-1641
Mailing Address - Fax:541-744-1052
Practice Address - Street 1:1750 WILLOW CREEK CIR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9152
Practice Address - Country:US
Practice Address - Phone:541-744-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0007506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORRPH-0007506OtherOREGON STATE BOARD OF PHARMACY