Provider Demographics
NPI:1740656164
Name:DENTINO, KARIN (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:
Last Name:DENTINO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KARIN
Other - Middle Name:
Other - Last Name:KIESLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:22832 US HIGHWAY 281 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-7430
Mailing Address - Country:US
Mailing Address - Phone:210-679-2369
Mailing Address - Fax:210-679-2379
Practice Address - Street 1:22832 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7430
Practice Address - Country:US
Practice Address - Phone:210-679-2369
Practice Address - Fax:210-679-2379
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX56987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist