Provider Demographics
NPI:1679174205
Name:KOENIG, KATHERINE ROSE
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROSE
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 1:17534 KAREN ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-2670
Mailing Address - Country:US
Mailing Address - Phone:402-894-0405
Mailing Address - Fax:
Practice Address - Street 1:17810 WELCH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1620
Practice Address - Country:US
Practice Address - Phone:402-891-0600
Practice Address - Fax:402-891-1239
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist