Provider Demographics
NPI:1033943089
Name:SURGI, KARISSA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:KARISSA
Middle Name:MARIE
Last Name:SURGI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:KARISSA
Other - Middle Name:MARIE
Other - Last Name:DEGANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:3201 MC CLELLAND BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3502
Mailing Address - Country:US
Mailing Address - Phone:417-347-6337
Mailing Address - Fax:417-347-6336
Practice Address - Street 1:3201 MC CLELLAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3502
Practice Address - Country:US
Practice Address - Phone:417-347-6337
Practice Address - Fax:417-347-6336
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022025590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist