Healthcare Provider Details

I. General information

NPI: 1508175209
Provider Name (Legal Business Name): KAREN A MIKULKA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 12/08/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LITITZ PIKE
LITITZ PA
17543-9327
US

IV. Provider business mailing address

233 KINGSBRIDGE DR
LITITZ PA
17543-9273
US

V. Phone/Fax

Practice location:
  • Phone: 717-627-8251
  • Fax:
Mailing address:
  • Phone: 717-581-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP039082L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: