Provider Demographics
NPI:1003102690
Name:CRUZ, MARISSA D (PHARM D)
Entity Type:Individual
Prefix:MS
First Name:MARISSA
Middle Name:D
Last Name:CRUZ
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 1:1000 CARR 167 STE 2
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-5560
Mailing Address - Country:US
Mailing Address - Phone:787-787-8989
Mailing Address - Fax:
Practice Address - Street 1:1000 CARR 167 STE 2
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-5560
Practice Address - Country:US
Practice Address - Phone:787-787-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5202183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist