Provider Demographics
NPI:1255709911
Name:NELSON, KAREN KATHLEEN
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:KATHLEEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:KATHLEEN
Other - Last Name:NELSON-KOOP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1521 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:FIRCREST
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6643
Mailing Address - Country:US
Mailing Address - Phone:253-324-0873
Mailing Address - Fax:
Practice Address - Street 1:1521 EDWARDS AVE
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6643
Practice Address - Country:US
Practice Address - Phone:253-324-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00068389183500000X
ORRPH-0009088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist