Provider Demographics
NPI:1992305759
Name:MORISSEAU, KAREN
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:MORISSEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 POTTER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1646
Mailing Address - Country:US
Mailing Address - Phone:401-374-4283
Mailing Address - Fax:
Practice Address - Street 1:199 CONNELL HWY
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-1033
Practice Address - Country:US
Practice Address - Phone:401-848-5861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH239294183500000X
RIRPH02908183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist