Provider Demographics
NPI:1083919716
Name:KING, KARRIE BROOKE
Entity Type:Individual
Prefix:DR
First Name:KARRIE
Middle Name:BROOKE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 LAKEVIEW RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-9742
Mailing Address - Country:US
Mailing Address - Phone:901-465-9243
Mailing Address - Fax:901-465-6822
Practice Address - Street 1:201 LAKEVIEW RD
Practice Address - Street 2:SUITE C
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-9742
Practice Address - Country:US
Practice Address - Phone:901-465-9243
Practice Address - Fax:901-465-6822
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist