Provider Demographics
NPI:1588251706
Name:KLARDIE, COLEEN (RPH)
Entity type:Individual
Prefix:
First Name:COLEEN
Middle Name:
Last Name:KLARDIE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 KILTON RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6522
Mailing Address - Country:US
Mailing Address - Phone:603-622-2320
Mailing Address - Fax:603-222-9219
Practice Address - Street 1:7 KILTON RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6522
Practice Address - Country:US
Practice Address - Phone:603-622-2320
Practice Address - Fax:603-222-9219
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3137183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist