Provider Demographics
NPI:1023247319
Name:KLUG, LAURA KRISTINE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:KRISTINE
Last Name:KLUG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:CARTER LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51510-1145
Mailing Address - Country:US
Mailing Address - Phone:605-660-1788
Mailing Address - Fax:
Practice Address - Street 1:2500 CALIFORNIA PLZ
Practice Address - Street 2:HLSB 165
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68178-0133
Practice Address - Country:US
Practice Address - Phone:402-280-4717
Practice Address - Fax:402-280-3320
Is Sole Proprietor?:No
Enumeration Date:2009-07-07
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13249183500000X
SD5700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist