Provider Demographics
NPI:1821291410
Name:FOREMAN, KARL RAY (RPH PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:RAY
Last Name:FOREMAN
Suffix:
Gender:M
Credentials:RPH PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 FRANCES DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-6967
Mailing Address - Country:US
Mailing Address - Phone:970-622-8271
Mailing Address - Fax:970-532-4799
Practice Address - Street 1:PO BOX V
Practice Address - Street 2:330 MOUNTAIN AVE
Practice Address - City:BERTHOUD
Practice Address - State:CO
Practice Address - Zip Code:80513-0620
Practice Address - Country:US
Practice Address - Phone:970-532-2034
Practice Address - Fax:970-532-4799
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15776183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist