Provider Demographics
NPI:1871089219
Name:KLASS, MARIAN JOYCE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:JOYCE
Last Name:KLASS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARIAN
Other - Middle Name:JOYCE
Other - Last Name:LYFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1850 W REPUBLIC RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5730
Mailing Address - Country:US
Mailing Address - Phone:417-891-4800
Mailing Address - Fax:
Practice Address - Street 1:1850 W REPUBLIC RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5730
Practice Address - Country:US
Practice Address - Phone:417-891-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180246321835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2018024632OtherBOARD OF PHARMACY