Provider Demographics
NPI:1336493725
Name:MCNALLY, KAREN A (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:MCNALLY
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 1:447 INNSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3035
Mailing Address - Country:US
Mailing Address - Phone:734-667-3514
Mailing Address - Fax:
Practice Address - Street 1:44300 FORD RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3169
Practice Address - Country:US
Practice Address - Phone:734-459-3875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist