Provider Demographics
NPI:1245583889
Name:SMITH, KAREN COUGHLIN (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:COUGHLIN
Last Name:SMITH
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 1:23 LOGAN WAY
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-5608
Mailing Address - Country:US
Mailing Address - Phone:541-789-5850
Mailing Address - Fax:541-789-5851
Practice Address - Street 1:2900 E BARNETT RD STE 1
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8380
Practice Address - Country:US
Practice Address - Phone:541-789-5850
Practice Address - Fax:541-789-5851
Is Sole Proprietor?:No
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0010014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist