Healthcare Provider Details

I. General information

NPI: 1942292768
Provider Name (Legal Business Name): MARY ANN KLIETHERMES PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 S WOOD ST
CHICAGO IL
60612-4325
US

IV. Provider business mailing address

160 KENMORE AVE
ELMHURST IL
60126-3518
US

V. Phone/Fax

Practice location:
  • Phone: 312-996-6787
  • Fax:
Mailing address:
  • Phone: 630-833-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: