Healthcare Provider Details

I. General information

NPI: 1366851172
Provider Name (Legal Business Name): MARTIN LAWRENCE KLAUS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GAMMA DR
PITTSBURGH PA
15238-2963
US

IV. Provider business mailing address

222 SEANOR RD
IRWIN PA
15642-9441
US

V. Phone/Fax

Practice location:
  • Phone: 412-449-0680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP439023
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: