Provider Demographics
NPI:1306089446
Name:KRAKE, KAREN MARIE (RPH)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:KRAKE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:MARIE
Other - Last Name:ONEIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:507 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1613
Mailing Address - Country:US
Mailing Address - Phone:734-243-6700
Mailing Address - Fax:734-242-2112
Practice Address - Street 1:507 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1613
Practice Address - Country:US
Practice Address - Phone:734-243-6700
Practice Address - Fax:734-242-2112
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-18
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI410617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist