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NPI Code Detail

MEDICARE: MR. RANDALL KLEMM RPH

MEDICARE: MR. RANDALL KLEMM 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
1183500000XPharmacistRPH-0007506OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RPH-0007506OTHEROROREGON STATE BOARD OF PHARMACY

General Provider Information

NPI Number : 1912221441
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL KLEMM RPH
Provider Business Mailing Address
First Line : PO BOX 2767
Second Line :
City : EUGENE
State : OR
Zip : 97402-0308
Country : US
Telephone Number : 541-744-1641
Fax Number : 541-744-1052
Provider Business Practice Location Address
First Line : 1750 WILLOW CREEK CIR
Second Line :
City : EUGENE
State : OR
Zip : 97402-9152
Country : US
Telephone Number : 541-744-1641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2010
Last Update Date : 07/26/2013

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