MEDICARE: DR. KARRI LYNN BLOOM PHARM. D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	S013296	AZ

General Provider Information

NPI Number	:	1023331451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARRI LYNN BLOOM PHARM. D

Provider Business Mailing Address
First Line	:	4410 W CACTUS RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2338
Country	:	US
Telephone Number	:	602-938-5087
Fax Number	:	602-938-6293

Provider Business Practice Location Address
First Line	:	4410 W CACTUS RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85304-2338
Country	:	US
Telephone Number	:	602-938-5087
Fax Number	:	602-938-6293

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2010
Last Update Date	:	03/13/2010

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