Healthcare Provider Details

I. General information

NPI: 1144408519
Provider Name (Legal Business Name): KAREN BERNICE MCCOMB RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 N MAIN ST
NORTHVILLE NY
12134-3550
US

IV. Provider business mailing address

PO BOX 61
SPECULATOR NY
12164-0061
US

V. Phone/Fax

Practice location:
  • Phone: 518-863-6524
  • Fax:
Mailing address:
  • Phone: 518-548-6105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number026690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: