Provider Demographics
NPI:1033206297
Name:KAREN'S FAMILY PHARMACY
Entity Type:Organization
Organization Name:KAREN'S FAMILY PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:208-788-4970
Mailing Address - Street 1:21 E MAPLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:HAILEY
Mailing Address - State:ID
Mailing Address - Zip Code:83333-8401
Mailing Address - Country:US
Mailing Address - Phone:208-788-4970
Mailing Address - Fax:208-788-5791
Practice Address - Street 1:21 E MAPLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:HAILEY
Practice Address - State:ID
Practice Address - Zip Code:83333-8401
Practice Address - Country:US
Practice Address - Phone:208-788-4970
Practice Address - Fax:208-788-5791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KAREN E FISHER ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-09
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID831CP3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1911064Medicare PIN