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General NPI Number Information
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NPI Number | 1396161618
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Entity Type | Individual
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Provider Name | CARISSA VIRTUE
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Gender | Female
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 604A E SOUTH ST
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City | OZARK
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State | MO
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Zip | 65721-8912
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Country | US
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Telephone | 417-581-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1206 W ROBIN ST
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City | OZARK
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State | MO
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Zip | 65721-8091
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Country | US
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Telephone | 417-619-3640
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2012021905
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License Number State | MO
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