MEDICARE: MR. THOMAS J KLOCKE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	03-3-11776	OH

General Provider Information

NPI Number	:	1639278302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS J KLOCKE RPH

Provider Business Mailing Address
First Line	:	2333 RAEBURN TER
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1231
Country	:	US
Telephone Number	:	513-681-8351
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 RAEBURN TER
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45223-1231
Country	:	US
Telephone Number	:	513-681-8351
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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