Provider Demographics
NPI:1669792925
Name:KLEIN, GINA TERESA (RPH)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:TERESA
Last Name:KLEIN
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 1:621 CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:JEANNETTE
Mailing Address - State:PA
Mailing Address - Zip Code:15644-3409
Mailing Address - Country:US
Mailing Address - Phone:724-527-3888
Mailing Address - Fax:
Practice Address - Street 1:621 CLAY AVE
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-3409
Practice Address - Country:US
Practice Address - Phone:724-527-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP037102R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP037102ROtherSTATE LICENSE
TX27201OtherSTATE LICENSE