=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538424403
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KARI RAE EDGELL PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2012
-----------------------------------------------------
Last Update Date | 07/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2935 BASTILLE AVE SE
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97306-8819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-393-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2935 BASTILLE AVE SE
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97306-8819
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-396-4586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH-0013144
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------