Provider Demographics
NPI:1245584432
Name:JACKSON, KAREN MEHLMAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MEHLMAN
Last Name:JACKSON
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 1:1200 WOODRUFF RD STE C28
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5751
Mailing Address - Country:US
Mailing Address - Phone:864-288-0816
Mailing Address - Fax:
Practice Address - Street 1:1200 WOODRUFF RD STE C28
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5751
Practice Address - Country:US
Practice Address - Phone:864-288-0816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist