Provider Demographics
NPI:1043593361
Name:MAC, KAREN LOUISE (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LOUISE
Last Name:MAC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 S OLD US 23
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-7524
Mailing Address - Country:US
Mailing Address - Phone:810-229-5466
Mailing Address - Fax:810-229-5593
Practice Address - Street 1:5505 S OLD US 23
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-7524
Practice Address - Country:US
Practice Address - Phone:810-229-5466
Practice Address - Fax:810-229-5593
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist