Provider Demographics
NPI:1487999629
Name:BORSHEIM, KAREN (RPHH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BORSHEIM
Suffix:
Gender:F
Credentials:RPHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 W TWIN WILLOWS DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-6872
Mailing Address - Country:US
Mailing Address - Phone:920-731-0871
Mailing Address - Fax:
Practice Address - Street 1:1000 W NORTHLAND AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914-1419
Practice Address - Country:US
Practice Address - Phone:920-739-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9715-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI9715-40OtherPHARMACISTS LISCENCE