Healthcare Provider Details

I. General information

NPI: 1568688786
Provider Name (Legal Business Name): KAREN M FANCHER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 MAGNOLIA DRIVE MOFFITT CANCER CENTER, PHARMACY DEPT
TAMPA FL
33612
US

IV. Provider business mailing address

5007 KIMBERTON CT
TAMPA FL
33647-2047
US

V. Phone/Fax

Practice location:
  • Phone: 813-745-4640
  • Fax: 813-979-3994
Mailing address:
  • Phone: 813-977-2984
  • Fax: 813-979-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS34822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: