1538775010 NPI number — KAREN C HENRY PHARMD

Table of content: KAREN C HENRY PHARMD (NPI 1538775010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538775010 NPI number — KAREN C HENRY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HENRY
Provider First Name:
KAREN
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538775010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3363 E 3500 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIMBERLY
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83341-5219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-421-2968
Provider Business Mailing Address Fax Number:
208-733-8325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 MAIN AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-6194
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-733-8323
Provider Business Practice Location Address Fax Number:
208-733-8325
Provider Enumeration Date:
09/19/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  P5098 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)