Provider Demographics
NPI:1306271416
Name:KLINKERMAN, DEBORAH JO (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JO
Last Name:KLINKERMAN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:JO
Other - Last Name:EMBREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:3201 MANAWA CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7672
Mailing Address - Country:US
Mailing Address - Phone:712-366-1315
Mailing Address - Fax:
Practice Address - Street 1:3201 MANAWA CENTRE DR
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51501-7672
Practice Address - Country:US
Practice Address - Phone:712-366-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA21840183500000X
KS1-13148183500000X
NE14087183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
226640OtherNABP