MEDICARE: MS. KAREN KOENIG

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	7839	AZ

General Provider Information

NPI Number	:	1548573603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN KOENIG

Provider Business Mailing Address
First Line	:	1131 W AUBURN DR
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85283-1615
Country	:	US
Telephone Number	:	480-730-9822
Fax Number	:

Provider Business Practice Location Address
First Line	:	3036 E THOMAS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-8014
Country	:	US
Telephone Number	:	602-468-9188
Fax Number	:	602-468-0939

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

Provider Enumeration Date	:	07/19/2010
Last Update Date	:	07/19/2010

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