Provider Demographics
NPI:1972103109
Name:KLOTZ, LYNDA ALENE (RPH)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:ALENE
Last Name:KLOTZ
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 1:15803 JAMIE LEE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-3748
Mailing Address - Country:US
Mailing Address - Phone:713-503-4398
Mailing Address - Fax:
Practice Address - Street 1:15955 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2513
Practice Address - Country:US
Practice Address - Phone:281-855-1305
Practice Address - Fax:281-855-1007
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist