Provider Demographics
NPI:1174736391
Name:NELSEN, KAREN (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:NELSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 WICKFORD DR
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-9342
Mailing Address - Country:US
Mailing Address - Phone:269-762-4598
Mailing Address - Fax:
Practice Address - Street 1:714 SHOPPERS LN
Practice Address - Street 2:
Practice Address - City:PARCHMENT
Practice Address - State:MI
Practice Address - Zip Code:49004-1118
Practice Address - Country:US
Practice Address - Phone:269-349-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020370971835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric