Provider Demographics
NPI:1205599107
Name:KLEIN, JUSTIN TYLER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:TYLER
Last Name:KLEIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 JADE DR
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-3311
Mailing Address - Country:US
Mailing Address - Phone:847-848-7979
Mailing Address - Fax:
Practice Address - Street 1:4815 MAPLE DR
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:IA
Practice Address - Zip Code:50327-2028
Practice Address - Country:US
Practice Address - Phone:515-265-6144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24261183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist