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NPI Code Detail

MEDICARE: MS. KAREN EGESDAL D.PH

MEDICARE: MS. KAREN EGESDAL D.PH
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
1183500000XPharmacist11159OK
2183500000XPharmacist43076CA
3183500000XPharmacistS09340AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111159OTHEROKPHARMACIST LISCENSE
2S09340OTHERAZARIZONA PHARMACIST LISCEN
343076OTHERCAPHARMACIST LISCENSE

General Provider Information

NPI Number : 1104813203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAREN EGESDAL D.PH
Provider Business Mailing Address
First Line : 2201 IVY GLENN CT
Second Line :
City : EDMOND
State : OK
Zip : 73034-4231
Country : US
Telephone Number : 405-348-1864
Fax Number :
Provider Business Practice Location Address
First Line : 4545 N LINCOLN BLVD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-3413
Country : US
Telephone Number : 405-522-7459
Fax Number : 405-530-3390
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 07/08/2007

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