MEDICARE: MS. KAREN KOENIG-HERMAN

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	03112135	OH

General Provider Information

NPI Number	:	1790108371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KAREN KOENIG-HERMAN

Provider Business Mailing Address
First Line	:	1900 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1017
Country	:	US
Telephone Number	:	937-335-1636
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 W MAIN ST
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1017
Country	:	US
Telephone Number	:	937-335-1636
Fax Number	:

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

Provider Enumeration Date	:	02/02/2014
Last Update Date	:	02/02/2014

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