Provider Demographics
NPI:1164592473
Name:AMIDON, KAREN SUE (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:SUE
Last Name:AMIDON
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 1:430 TRAIL VIEW LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-5628
Mailing Address - Country:US
Mailing Address - Phone:972-682-5438
Mailing Address - Fax:
Practice Address - Street 1:4700 N GALLOWAY AVE
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-1516
Practice Address - Country:US
Practice Address - Phone:972-698-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308131835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30813OtherPHARMACY LICENSE NUMBER