Provider Demographics
NPI:1811510639
Name:KLOSTERMAN, MAEGAN NICHOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:NICHOLE
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14242 PROVIDENCE PIKE
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9709
Mailing Address - Country:US
Mailing Address - Phone:937-901-5791
Mailing Address - Fax:
Practice Address - Street 1:14242 PROVIDENCE PIKE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-9709
Practice Address - Country:US
Practice Address - Phone:937-901-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032331381835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist