Provider Demographics
NPI:1104813203
Name:EGESDAL, KAREN (DPH)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:
Last Name:EGESDAL
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 IVY GLENN CT
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-4231
Mailing Address - Country:US
Mailing Address - Phone:405-348-1864
Mailing Address - Fax:
Practice Address - Street 1:4545 N LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-3413
Practice Address - Country:US
Practice Address - Phone:405-522-7459
Practice Address - Fax:405-530-3390
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK11159183500000X
CA43076183500000X
AZS09340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK11159OtherPHARMACIST LISCENSE
AZS09340OtherARIZONA PHARMACIST LISCEN
CA43076OtherPHARMACIST LISCENSE