Provider Demographics
NPI:1255664074
Name:KARNES, JACKLYN MICHELLE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JACKLYN
Middle Name:MICHELLE
Last Name:KARNES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9308 HOLM BURSUN DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5313
Mailing Address - Country:US
Mailing Address - Phone:505-877-1227
Mailing Address - Fax:
Practice Address - Street 1:1625 RIO BRAVO BLVD SW STE 16
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6041
Practice Address - Country:US
Practice Address - Phone:505-877-3130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007159183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist