Provider Demographics
NPI:1538775010
Name:HENRY, KAREN C (PHARMD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:C
Last Name:HENRY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 E 3500 N
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:ID
Mailing Address - Zip Code:83341-5219
Mailing Address - Country:US
Mailing Address - Phone:208-421-2968
Mailing Address - Fax:208-733-8325
Practice Address - Street 1:139 MAIN AVE W
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-6194
Practice Address - Country:US
Practice Address - Phone:208-733-8323
Practice Address - Fax:208-733-8325
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP50983336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy