Healthcare Provider Details

I. General information

NPI: 1124902978
Provider Name (Legal Business Name): KARISSA RAE KOESSEL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2025
Last Update Date: 08/04/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23625 HOLMAN HWY
MONTEREY CA
93940-5902
US

IV. Provider business mailing address

4190 BYRON ST APT A
PALO ALTO CA
94306-4710
US

V. Phone/Fax

Practice location:
  • Phone: 831-624-5311
  • Fax:
Mailing address:
  • Phone: 602-670-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number89738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: