MEDICARE: MS. KARISSA BOODHOO PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	067567	NY

General Provider Information

NPI Number	:	1982292454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARISSA BOODHOO PHARMD

Provider Business Mailing Address
First Line	:	8026 260TH ST
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1202
Country	:	US
Telephone Number	:	718-598-1461
Fax Number	:	718-343-1846

Provider Business Practice Location Address
First Line	:	3766 82ND ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7006
Country	:	US
Telephone Number	:	718-507-8056
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2021
Last Update Date	:	03/15/2022

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