Provider Demographics
NPI:1023349990
Name:KLODA, GEORGE F (PHARMACIST)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:F
Last Name:KLODA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RUSSELL RD
Mailing Address - Street 2:
Mailing Address - City:ELIOT
Mailing Address - State:ME
Mailing Address - Zip Code:03903-1332
Mailing Address - Country:US
Mailing Address - Phone:207-439-8343
Mailing Address - Fax:
Practice Address - Street 1:1 RUSSELL RD
Practice Address - Street 2:
Practice Address - City:ELIOT
Practice Address - State:ME
Practice Address - Zip Code:03903-1332
Practice Address - Country:US
Practice Address - Phone:207-439-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-16
Last Update Date:2010-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER3010183500000X
NHR0681183500000X
IL05128345183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist