Healthcare Provider Details

I. General information

NPI: 1396860367
Provider Name (Legal Business Name): KAREN DIANE BLISS RPH, CCP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 BOBWHITE DR
CHERRY HILL NJ
08003-3103
US

IV. Provider business mailing address

1025 BOBWHITE DR
CHERRY HILL NJ
08003-3103
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-5762
  • Fax:
Mailing address:
  • Phone: 856-428-5762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036396L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI02041100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: