Provider Demographics
NPI:1982272688
Name:BANNEN, KAREN RENEE
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:RENEE
Last Name:BANNEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COVERED VLG
Mailing Address - Street 2:
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-1683
Mailing Address - Country:US
Mailing Address - Phone:616-794-2200
Mailing Address - Fax:616-794-5171
Practice Address - Street 1:100 COVERED VLG
Practice Address - Street 2:
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-1683
Practice Address - Country:US
Practice Address - Phone:616-794-2200
Practice Address - Fax:616-794-5171
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303007621183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician