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General NPI Number Information
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NPI Number | 1427512516
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Entity Type | Individual
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Provider Name | MIKE WILLIAM KLEPZIG RPH
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Gender | Male
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Dates
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Enumeration Date | 01/23/2019
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 9065 SANDIDGE CENTER CV STE A
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-3574
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Country | US
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Telephone | 662-892-8448
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Fax |
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Provider Business Mailing Address
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Address Line | 4383 SPRING PLACE DR
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-8210
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Country | US
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Telephone | 901-210-8451
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Fax | 332-892-8189
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | T-08678
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License Number State | MS
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