Provider Demographics
NPI:1417367988
Name:KLEM, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KLEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19450 GULF BLVD APT 401
Mailing Address - Street 2:
Mailing Address - City:INDIAN SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33785-2260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19450 GULF BLVD APT 401
Practice Address - Street 2:
Practice Address - City:INDIAN SHORES
Practice Address - State:FL
Practice Address - Zip Code:33785-2260
Practice Address - Country:US
Practice Address - Phone:727-207-3038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32661183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS32661OtherPHARMACIST LICENSE