Provider Demographics
NPI:1275972739
Name:MACK, KAREN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:MACK
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 1:793 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43222-1551
Mailing Address - Country:US
Mailing Address - Phone:614-234-1513
Mailing Address - Fax:614-234-1387
Practice Address - Street 1:3595 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3440
Practice Address - Country:US
Practice Address - Phone:614-566-3333
Practice Address - Fax:614-566-1107
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03316839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist