Provider Demographics
NPI:1548573603
Name:KOENIG, KAREN
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:KOENIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 W AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1615
Mailing Address - Country:US
Mailing Address - Phone:480-730-9822
Mailing Address - Fax:
Practice Address - Street 1:3036 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-8014
Practice Address - Country:US
Practice Address - Phone:602-468-9188
Practice Address - Fax:602-468-0939
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7839183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist