Provider Demographics
NPI:1710580451
Name:LABORN, KAREN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LABORN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2975 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-2113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2975 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-2113
Practice Address - Country:US
Practice Address - Phone:317-283-6713
Practice Address - Fax:317-283-2825
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26022811A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100303290AMedicaid