Provider Demographics
NPI:1023022373
Name:CAYABYAB, MARISSA ROSARIO (RPH)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:ROSARIO
Last Name:CAYABYAB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARISSA
Other - Middle Name:ESTRADA
Other - Last Name:ROSARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:6927 ROSETREE PL
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-5750
Mailing Address - Country:US
Mailing Address - Phone:513-398-3459
Mailing Address - Fax:
Practice Address - Street 1:4100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45428-9000
Practice Address - Country:US
Practice Address - Phone:937-268-6511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-18349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist