Provider Demographics
NPI:1982098786
Name:KLINEFELTER, CAROLYN
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:KLINEFELTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 PADDOCK CLUB LN
Mailing Address - Street 2:UNIT 108
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5553
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1631 PADDOCK CLUB LN
Practice Address - Street 2:UNIT 108
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-5553
Practice Address - Country:US
Practice Address - Phone:704-544-2092
Practice Address - Fax:704-544-8251
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24767183500000X
SC35902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist