Provider Demographics
NPI:1356615298
Name:KLOC, KAYLA JONETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JONETTE
Last Name:KLOC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:JONETTE
Other - Last Name:BUSCHKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:755 E MCDOWELL RD
Mailing Address - Street 2:ANTICOAGULATION SERVICE
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2506
Mailing Address - Country:US
Mailing Address - Phone:602-271-5416
Mailing Address - Fax:602-271-5383
Practice Address - Street 1:755 E MCDOWELL RD
Practice Address - Street 2:ANTICOAGULATION SERVICE
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2506
Practice Address - Country:US
Practice Address - Phone:602-271-5416
Practice Address - Fax:602-271-5383
Is Sole Proprietor?:No
Enumeration Date:2012-02-23
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist