Provider Demographics
NPI:1528119864
Name:KARSKY, KEITH ALLEN (RPH)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALLEN
Last Name:KARSKY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2242
Mailing Address - Country:US
Mailing Address - Phone:320-255-1433
Mailing Address - Fax:320-229-5168
Practice Address - Street 1:1900 CENTRACARE CIR
Practice Address - Street 2:SUITE 1350
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-229-4904
Practice Address - Fax:320-229-5168
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114466-4183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist