Provider Demographics
NPI:1295256626
Name:KLEINERT, PATRICIA S (PHARMD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:S
Last Name:KLEINERT
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 1:1529 MUD CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ALTO
Mailing Address - State:GA
Mailing Address - Zip Code:30510-2631
Mailing Address - Country:US
Mailing Address - Phone:770-530-8903
Mailing Address - Fax:706-778-0474
Practice Address - Street 1:250 FURNITURE DR
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531
Practice Address - Country:US
Practice Address - Phone:706-778-0474
Practice Address - Fax:706-778-0474
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014694183500000X
GARPH014694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist