=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407480908
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAREN JILL BIRDSELL RPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2020
-----------------------------------------------------
Last Update Date | 02/24/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 SW 2ND ST
-----------------------------------------------------
City | TULIA
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79088-2747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-995-3551
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 252
-----------------------------------------------------
City | TURKEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79261-0252
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 806-423-1301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 37332
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------