Provider Demographics
NPI:1629473194
Name:BLEAKLEY, KAREN (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BLEAKLEY
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15618 COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-1630
Mailing Address - Country:US
Mailing Address - Phone:301-421-4493
Mailing Address - Fax:
Practice Address - Street 1:15618 COLUMBIA PIKE
Practice Address - Street 2:
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866-1630
Practice Address - Country:US
Practice Address - Phone:301-421-4493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist