Healthcare Provider Details

I. General information

NPI: 1346991619
Provider Name (Legal Business Name): KAREN LYNNE MUNRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GENESYS PKWY STE 1430
GRAND BLANC MI
48439-8065
US

IV. Provider business mailing address

9501 HICKORY HOLLOW CT
DAVISON MI
48423-7937
US

V. Phone/Fax

Practice location:
  • Phone: 810-606-7612
  • Fax: 810-606-7610
Mailing address:
  • Phone: 517-614-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5302038354
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: