Healthcare Provider Details

I. General information

NPI: 1902830094
Provider Name (Legal Business Name): KAREN S WALL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13500 N MERIDIAN ST
CARMEL IN
46032-1456
US

IV. Provider business mailing address

4811 S COBBLESTONE DR
ZIONSVILLE IN
46077-8977
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8096
  • Fax: 317-582-7385
Mailing address:
  • Phone: 317-769-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9422
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number011877
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number26022683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: