Provider Demographics
NPI:1720323025
Name:MYERS, KARENE ANTONETTE (RPH, PHARMD, BS)
Entity Type:Individual
Prefix:DR
First Name:KARENE
Middle Name:ANTONETTE
Last Name:MYERS
Suffix:
Gender:F
Credentials:RPH, PHARMD, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 W HAYMEADOW LN
Mailing Address - Street 2:APT 3A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-3152
Mailing Address - Country:US
Mailing Address - Phone:309-966-4274
Mailing Address - Fax:
Practice Address - Street 1:1200 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1200
Practice Address - Country:US
Practice Address - Phone:309-673-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-28
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0512916321835G0303X, 1835P0018X, 1835X0200X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835X0200XPharmacy Service ProvidersPharmacistOncology