Provider Demographics
NPI:1982292454
Name:BOODHOO, KARISSA (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:KARISSA
Middle Name:
Last Name:BOODHOO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 260TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1202
Mailing Address - Country:US
Mailing Address - Phone:718-598-1461
Mailing Address - Fax:718-343-1846
Practice Address - Street 1:3766 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7006
Practice Address - Country:US
Practice Address - Phone:718-507-8056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-09
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067567183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist