MEDICARE: PATRICIA MARIE KLATZKE RPH

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	5302026831	MI

General Provider Information

NPI Number	:	1427224450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MARIE KLATZKE RPH

Provider Business Mailing Address
First Line	:	40220 LIZABETH DR
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-4032
Country	:	US
Telephone Number	:	586-264-8534
Fax Number	:

Provider Business Practice Location Address
First Line	:	39000 VAN DYKE AVE
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48313-4613
Country	:	US
Telephone Number	:	586-268-2500
Fax Number	:	586-977-1903

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

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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