Provider Demographics
NPI:1174042584
Name:KLOOS, STEPHANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:KLOOS
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 1:208 MARGARET AVE
Mailing Address - Street 2:
Mailing Address - City:EVANS CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16033-9262
Mailing Address - Country:US
Mailing Address - Phone:724-612-8451
Mailing Address - Fax:
Practice Address - Street 1:100 SEVEN FIELDS BLVD
Practice Address - Street 2:
Practice Address - City:SEVEN FIELDS
Practice Address - State:PA
Practice Address - Zip Code:16046-4345
Practice Address - Country:US
Practice Address - Phone:724-742-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist