Provider Demographics
NPI:1164032322
Name:HART, KAREN WHEELER (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:WHEELER
Last Name:HART
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17633 GUNN HWY # 126
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1912
Mailing Address - Country:US
Mailing Address - Phone:205-960-4695
Mailing Address - Fax:
Practice Address - Street 1:7121 STEPHANIE LN STE 104
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5352
Practice Address - Country:US
Practice Address - Phone:205-960-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist