Provider Demographics
NPI:1699117960
Name:KLOCKAU, CHRISTOPHER LEE (PHARMD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
Last Name:KLOCKAU
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:KIT
Other - Middle Name:LEE
Other - Last Name:KLOCKAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:PO BOX 619
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CO
Mailing Address - Zip Code:80446-0619
Mailing Address - Country:US
Mailing Address - Phone:970-887-7150
Mailing Address - Fax:970-887-7151
Practice Address - Street 1:1001 THOMPSON RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CO
Practice Address - Zip Code:80446
Practice Address - Country:US
Practice Address - Phone:970-887-7150
Practice Address - Fax:970-887-7151
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist