Healthcare Provider Details

I. General information

NPI: 1366101941
Provider Name (Legal Business Name): MS. KARSTA ANN LIEB
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 W OLIVE AVE
MADERA CA
93637-5402
US

IV. Provider business mailing address

335 W OLIVE AVE
MADERA CA
93637-5402
US

V. Phone/Fax

Practice location:
  • Phone: 559-674-2182
  • Fax: 559-673-4107
Mailing address:
  • Phone: 559-674-2182
  • Fax: 559-673-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number92922
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: