Provider Demographics
NPI:1396461299
Name:KLAR, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:KLAR
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 1:25564 FINDLEY RD
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-9398
Mailing Address - Country:US
Mailing Address - Phone:269-625-3595
Mailing Address - Fax:
Practice Address - Street 1:625 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:MI
Practice Address - Zip Code:49028-1322
Practice Address - Country:US
Practice Address - Phone:517-858-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302030214183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist