Provider Demographics
NPI:1982981445
Name:KLOIBER, MATTHEW JAMES (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:KLOIBER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3147
Mailing Address - Country:US
Mailing Address - Phone:708-503-9193
Mailing Address - Fax:708-503-9245
Practice Address - Street 1:1401 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3147
Practice Address - Country:US
Practice Address - Phone:708-503-9193
Practice Address - Fax:708-503-9245
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.295099183500000X
IL051-2950991835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy