MEDICARE: DR. KAREN SUSAN OLES PHARMD, RPH

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	1835P1200X	Pharmacotherapy Pharmacist	07726	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	700062	OTHER	NC	CLINICAL PHARMACIST PRACT

General Provider Information

NPI Number	:	1649359118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAREN SUSAN OLES PHARMD, RPH

Provider Business Mailing Address
First Line	:	3815 FIRESTONE RD
Second Line	:
City	:	KERNERSVILLE
State	:	NC
Zip	:	27284-8212
Country	:	US
Telephone Number	:	336-993-4652
Fax Number	:	336-713-7028

Provider Business Practice Location Address
First Line	:	MEDICAL CENTER BOULEVARD
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27157-1069
Country	:	US
Telephone Number	:	336-713-7011
Fax Number	:	336-713-7028

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/08/2007

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