Provider Demographics
NPI:1588876163
Name:KLOMP, PAUL PARKINSON (RPH)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:PARKINSON
Last Name:KLOMP
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 1:3844 S 250 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-7626
Mailing Address - Country:US
Mailing Address - Phone:435-713-0908
Mailing Address - Fax:
Practice Address - Street 1:3844 S 250 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-7626
Practice Address - Country:US
Practice Address - Phone:435-713-0908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1330211701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist