Provider Demographics
NPI:1427512516
Name:KLEPZIG, MIKE WILLIAM (RPH)
Entity type:Individual
Prefix:MR
First Name:MIKE
Middle Name:WILLIAM
Last Name:KLEPZIG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4383 SPRING PLACE DR
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-8210
Mailing Address - Country:US
Mailing Address - Phone:901-210-8451
Mailing Address - Fax:332-892-8189
Practice Address - Street 1:9065 SANDIDGE CENTER CV STE A
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-3574
Practice Address - Country:US
Practice Address - Phone:662-892-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MST-08678183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist