MEDICARE: KAREN SUE BLENDER RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH009704	GA

General Provider Information

NPI Number	:	1396738027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN SUE BLENDER RPH

Provider Business Mailing Address
First Line	:	2950 MAJORS FARM CT
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-9326
Country	:	US
Telephone Number	:	770-205-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 NORTHSIDE FORSYTH DR
Second Line	:
City	:	CUMMING
State	:	GA
Zip	:	30041-7659
Country	:	US
Telephone Number	:	770-844-3396
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	07/08/2007

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