1023247319 NPI number — MISS LAURA KRISTINE KLUG PHARM.D.

Table of content: MISS LAURA KRISTINE KLUG PHARM.D. (NPI 1023247319)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023247319 NPI number — MISS LAURA KRISTINE KLUG PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUG
Provider First Name:
LAURA
Provider Middle Name:
KRISTINE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023247319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4426 N 17TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARTER LAKE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
51510-1145
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-660-1788
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 CALIFORNIA PLZ
Provider Second Line Business Practice Location Address:
HLSB 165
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68178-0133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-280-4717
Provider Business Practice Location Address Fax Number:
402-280-3320
Provider Enumeration Date:
07/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  13249 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 183500000X , with the licence number: 5700 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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