Provider Demographics
NPI:1952791030
Name:KARSTEN, MIKELL
Entity Type:Individual
Prefix:
First Name:MIKELL
Middle Name:
Last Name:KARSTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 ASHBURN HWY
Mailing Address - Street 2:
Mailing Address - City:SYLVESTER
Mailing Address - State:GA
Mailing Address - Zip Code:31791-1400
Mailing Address - Country:US
Mailing Address - Phone:229-776-3908
Mailing Address - Fax:229-776-7425
Practice Address - Street 1:502 ASHBURN HWY
Practice Address - Street 2:
Practice Address - City:SYLVESTER
Practice Address - State:GA
Practice Address - Zip Code:31791-1400
Practice Address - Country:US
Practice Address - Phone:229-776-3908
Practice Address - Fax:229-776-7425
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA012590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist