Provider Demographics
NPI:1124201314
Name:ZIOMEK, KAREN M (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:ZIOMEK
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 FAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-1628
Mailing Address - Country:US
Mailing Address - Phone:315-628-6138
Mailing Address - Fax:
Practice Address - Street 1:315 FAYETTE ST
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-1628
Practice Address - Country:US
Practice Address - Phone:315-628-6138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0257470Medicaid