Provider Demographics
NPI:1942913702
Name:KARMO, MALLORY MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:MARIE
Last Name:KARMO
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 1:4972 W POND CIR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-2278
Mailing Address - Country:US
Mailing Address - Phone:248-444-6389
Mailing Address - Fax:
Practice Address - Street 1:409 N MARKETPLACE BLVD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7732
Practice Address - Country:US
Practice Address - Phone:517-622-1451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302414729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist