Provider Demographics
NPI:1740724103
Name:KLEISS, CHARLES (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:KLEISS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:STEELTON
Mailing Address - State:PA
Mailing Address - Zip Code:17113-2521
Mailing Address - Country:US
Mailing Address - Phone:717-939-7272
Mailing Address - Fax:
Practice Address - Street 1:124 S FRONT ST
Practice Address - Street 2:
Practice Address - City:STEELTON
Practice Address - State:PA
Practice Address - Zip Code:17113-2521
Practice Address - Country:US
Practice Address - Phone:717-939-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP439206183500000X
FLPS35300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist