Healthcare Provider Details

I. General information

NPI: 1558487843
Provider Name (Legal Business Name): KAREN SUE MATHIS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 S SUMMIT ST
GIRARD KS
66743-1544
US

IV. Provider business mailing address

427 S 110TH ST
GIRARD KS
66743-2333
US

V. Phone/Fax

Practice location:
  • Phone: 620-724-8400
  • Fax: 620-724-6900
Mailing address:
  • Phone: 620-724-8071
  • Fax: 620-724-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13309
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: