MEDICARE: DR. KARMEN HAIDAR

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	RP443428	PA

General Provider Information

NPI Number	:	1952679516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARMEN HAIDAR

Provider Business Mailing Address
First Line	:	15 WEST MANOA RD
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083
Country	:	US
Telephone Number	:	267-752-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-1419
Country	:	US
Telephone Number	:	267-273-7585
Fax Number	:	267-273-7591

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

Provider Enumeration Date	:	12/09/2011
Last Update Date	:	12/09/2011

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