Provider Demographics
NPI:1770068819
Name:BOYOVICH, KARISSA AMBER (PHARM D)
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:AMBER
Last Name:BOYOVICH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-0536
Mailing Address - Country:US
Mailing Address - Phone:360-785-4711
Mailing Address - Fax:360-785-3109
Practice Address - Street 1:206 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596-9419
Practice Address - Country:US
Practice Address - Phone:360-785-4711
Practice Address - Fax:360-785-3109
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH60925699183500000X
ORRPH-0016861183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist