Provider Demographics
NPI:1902830094
Name:WALL, KAREN S (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:S
Last Name:WALL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4811 S COBBLESTONE DR
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8977
Mailing Address - Country:US
Mailing Address - Phone:317-769-0026
Mailing Address - Fax:
Practice Address - Street 1:13500 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1456
Practice Address - Country:US
Practice Address - Phone:317-582-8096
Practice Address - Fax:317-582-7385
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9422183500000X
KY011877183500000X
IN26022683A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist