Healthcare Provider Details

I. General information

NPI: 1306443064
Provider Name (Legal Business Name): KATELYN KLAPROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 E SAINT LOUIS ST
SPRINGFIELD MO
65806-2527
US

IV. Provider business mailing address

1155 E SAINT LOUIS ST
SPRINGFIELD MO
65806-2527
US

V. Phone/Fax

Practice location:
  • Phone: 417-862-5302
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2014026383
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: