Provider Demographics
NPI:1770865552
Name:FETTIG, KARYM ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:KARYM
Middle Name:ELIZABETH
Last Name:FETTIG
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 1:625 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3357
Mailing Address - Country:US
Mailing Address - Phone:617-491-8157
Mailing Address - Fax:617-491-6960
Practice Address - Street 1:625 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3357
Practice Address - Country:US
Practice Address - Phone:617-491-8157
Practice Address - Fax:617-491-6960
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19983183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist