Provider Demographics
NPI:1285218917
Name:LAMP, KAREN MARIE (EXCPT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:LAMP
Suffix:
Gender:F
Credentials:EXCPT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:GONZALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EXCPT
Mailing Address - Street 1:610 E 12TH ST
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-2759
Mailing Address - Country:US
Mailing Address - Phone:541-300-9191
Mailing Address - Fax:
Practice Address - Street 1:1400 W 6TH ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-3594
Practice Address - Country:US
Practice Address - Phone:541-298-5680
Practice Address - Fax:541-296-8587
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR08-03-700183700000X
ORCPT-0003682183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician