Provider Demographics
NPI:1023095684
Name:KLOPPMAN, MICHELLE ELIZABETH (PHARMACIST)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:KLOPPMAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:KLOPPMAN
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:1505 KLA OOK WA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TAHOLAH
Mailing Address - State:WA
Mailing Address - Zip Code:98587
Mailing Address - Country:US
Mailing Address - Phone:360-276-4405
Mailing Address - Fax:360-276-0188
Practice Address - Street 1:1505 KLA OOK WA DRIVE
Practice Address - Street 2:
Practice Address - City:TAHOLAH
Practice Address - State:WA
Practice Address - Zip Code:98587
Practice Address - Country:US
Practice Address - Phone:360-276-4405
Practice Address - Fax:360-276-0188
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-26
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00013686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPH00013686OtherPHARMACIST LICENSURE