Provider Demographics
NPI:1750856357
Name:KLATT, DUDLEY ILES II (PHARMD)
Entity type:Individual
Prefix:
First Name:DUDLEY
Middle Name:ILES
Last Name:KLATT
Suffix:II
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26921 ANEMONE BND
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-5073
Mailing Address - Country:US
Mailing Address - Phone:361-227-0412
Mailing Address - Fax:
Practice Address - Street 1:2425 BABCOCK RD STE 108A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4899
Practice Address - Country:US
Practice Address - Phone:210-298-9000
Practice Address - Fax:210-298-9001
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47607183500000X
OK16601183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist