Provider Demographics
NPI:1417569930
Name:CHRISTIE, CARISSA (PHARMD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:HURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:BAXTER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66713-1547
Mailing Address - Country:US
Mailing Address - Phone:620-856-5858
Mailing Address - Fax:620-856-3976
Practice Address - Street 1:1000 MILITARY AVE
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-1547
Practice Address - Country:US
Practice Address - Phone:620-856-5858
Practice Address - Fax:620-856-3976
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007023329183500000X
OK13480183500000X
KS1-13528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist