Provider Demographics
NPI:1306121207
Name:KLEVE, MARY AMY (RPH)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:AMY
Last Name:KLEVE
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 1:18719 US HIGHWAY 385
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:CO
Mailing Address - Zip Code:80734-9536
Mailing Address - Country:US
Mailing Address - Phone:505-980-3530
Mailing Address - Fax:970-854-2221
Practice Address - Street 1:1001 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:CO
Practice Address - Zip Code:80734-1854
Practice Address - Country:US
Practice Address - Phone:970-854-2222
Practice Address - Fax:970-854-2221
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist