Provider Demographics
NPI:1801916507
Name:BAVIRSHA, KARIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:BAVIRSHA
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 1:224 SURF DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1142
Mailing Address - Country:US
Mailing Address - Phone:815-463-8235
Mailing Address - Fax:
Practice Address - Street 1:19965 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-3105
Practice Address - Country:US
Practice Address - Phone:815-464-9439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist