Healthcare Provider Details

I. General information

NPI: 1487570297
Provider Name (Legal Business Name): SANDRA JEAN KLUKOW-THOMPSON RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 W 13TH ST
CARROLL IA
51401-1942
US

IV. Provider business mailing address

410 W 13TH ST
CARROLL IA
51401-1942
US

V. Phone/Fax

Practice location:
  • Phone: 712-794-5215
  • Fax: 712-792-7998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16911
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: