MEDICARE: MRS. SUZANNE RENEE KLYN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	044966	MO

General Provider Information

NPI Number	:	1285110098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUZANNE RENEE KLYN

Provider Business Mailing Address
First Line	:	8200 N LINDBERGH BLVD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7107
Country	:	US
Telephone Number	:	314-921-7345
Fax Number	:	314-921-7346

Provider Business Practice Location Address
First Line	:	8200 N LINDBERGH BLVD
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-7107
Country	:	US
Telephone Number	:	314-921-7345
Fax Number	:	314-921-7346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2018
Last Update Date	:	07/15/2018

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