Provider Demographics
NPI:1164769279
Name:GRITTANI, MARILENA (RPH)
Entity Type:Individual
Prefix:
First Name:MARILENA
Middle Name:
Last Name:GRITTANI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15960 DAM RD.
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422
Mailing Address - Country:US
Mailing Address - Phone:562-644-0739
Mailing Address - Fax:
Practice Address - Street 1:421 CAPE HENRY DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-2633
Practice Address - Country:US
Practice Address - Phone:562-644-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47980183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist