Healthcare Provider Details

I. General information

NPI: 1174736391
Provider Name (Legal Business Name): KAREN NELSEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 SHOPPERS LN
PARCHMENT MI
49004-1118
US

IV. Provider business mailing address

1531 WICKFORD DR
KALAMAZOO MI
49009-9342
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-7322
  • Fax:
Mailing address:
  • Phone: 269-762-4598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302037097
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: