Provider Demographics
NPI:1861591828
Name:HENNESEY, KAREN J (RPH)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:J
Last Name:HENNESEY
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 1:8931 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:WALES
Mailing Address - State:MI
Mailing Address - Zip Code:48027-1206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5283 LAPEER RD
Practice Address - Street 2:
Practice Address - City:KIMBALL
Practice Address - State:MI
Practice Address - Zip Code:48074-1422
Practice Address - Country:US
Practice Address - Phone:810-325-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302033658183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist