Healthcare Provider Details

I. General information

NPI: 1346527389
Provider Name (Legal Business Name): ANNE KLOSTERMAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 CERRILLOS RD
SANTE FE NM
87505
US

IV. Provider business mailing address

2308 CERRILLOS RD
SANTE FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-7874
  • Fax: 505-471-2172
Mailing address:
  • Phone: 505-471-7874
  • Fax: 505-471-2172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006882
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: