Provider Demographics
NPI:1144408519
Name:MCCOMB, KAREN BERNICE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:BERNICE
Last Name:MCCOMB
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:SPECULATOR
Mailing Address - State:NY
Mailing Address - Zip Code:12164-0061
Mailing Address - Country:US
Mailing Address - Phone:518-548-6105
Mailing Address - Fax:
Practice Address - Street 1:212 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:NY
Practice Address - Zip Code:12134-3550
Practice Address - Country:US
Practice Address - Phone:518-863-6524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist