Provider Demographics
NPI:1487825980
Name:KLOSE, RICHARD ALVIN JR (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALVIN
Last Name:KLOSE
Suffix:JR
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 1:2626 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-1737
Mailing Address - Country:US
Mailing Address - Phone:716-447-0297
Mailing Address - Fax:
Practice Address - Street 1:2626 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-1737
Practice Address - Country:US
Practice Address - Phone:716-447-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031764183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist