Provider Demographics
NPI:1588144877
Name:KLUS, ALYSSA DANIELLE (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:DANIELLE
Last Name:KLUS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 BUCKLAND RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-9781
Mailing Address - Country:US
Mailing Address - Phone:720-209-7864
Mailing Address - Fax:
Practice Address - Street 1:1500 E 3RD ST STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-3488
Practice Address - Country:US
Practice Address - Phone:704-526-4651
Practice Address - Fax:704-526-4653
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28160183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist