Provider Demographics
NPI:1366043291
Name:GARNER, KAREN MARIE
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282
Mailing Address - Country:US
Mailing Address - Phone:309-792-1531
Mailing Address - Fax:309-792-1518
Practice Address - Street 1:2001 5TH STREET
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282
Practice Address - Country:US
Practice Address - Phone:309-792-1531
Practice Address - Fax:309-792-1518
Is Sole Proprietor?:No
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040697183500000X
IL051-036697183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist