Provider Demographics
NPI:1962008961
Name:O'CONNOR, KAREN MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E11039 WYNSONG DR
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-9377
Mailing Address - Country:US
Mailing Address - Phone:608-356-2907
Mailing Address - Fax:
Practice Address - Street 1:2920 FITCHRONA RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53719-1802
Practice Address - Country:US
Practice Address - Phone:608-273-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI12420-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist