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NPI Code Detail

MEDICARE: MR. ROGER S. KLOTZ R.PH., BCNSP, FASCP

MEDICARE: MR. ROGER S. KLOTZ R.PH., BCNSP, FASCP
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
11835N1003XNutrition Support PharmacistRPH 38533CA
21835P1200XPharmacotherapy PharmacistRPH 38533CA
3183500000XPharmacistRPH 38533CA

General Provider Information

NPI Number : 1801898069
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ROGER S. KLOTZ R.PH., BCNSP, FASCP
Provider Business Mailing Address
First Line : PO BOX 17265
Second Line :
City : ANAHEIM
State : CA
Zip : 92817-7265
Country : US
Telephone Number : 714-998-3807
Fax Number : 714-974-8858
Provider Business Practice Location Address
First Line : 309 E 2ND ST
Second Line :
City : POMONA
State : CA
Zip : 91766-1854
Country : US
Telephone Number : 714-974-8858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/28/2010

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