Provider Demographics
NPI:1558487843
Name:MATHIS, KAREN SUE (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:SUE
Last Name:MATHIS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:427 S 110TH ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2333
Mailing Address - Country:US
Mailing Address - Phone:620-724-8071
Mailing Address - Fax:620-724-6900
Practice Address - Street 1:129 S SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-1544
Practice Address - Country:US
Practice Address - Phone:620-724-8400
Practice Address - Fax:620-724-6900
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist