Provider Demographics
NPI:1588110704
Name:KLOCKE, BRITNEY LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:BRITNEY
Middle Name:LYNN
Last Name:KLOCKE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8441 WAYZATA BLVD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1372
Mailing Address - Country:US
Mailing Address - Phone:952-542-5511
Mailing Address - Fax:
Practice Address - Street 1:8441 WAYZATA BLVD
Practice Address - Street 2:SUITE 340
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1372
Practice Address - Country:US
Practice Address - Phone:952-542-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1213301835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care