Provider Demographics
NPI:1164876819
Name:PEARSON, MARISA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:PEARSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-1018
Mailing Address - Country:US
Mailing Address - Phone:219-972-0364
Mailing Address - Fax:
Practice Address - Street 1:430 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-1018
Practice Address - Country:US
Practice Address - Phone:219-972-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025762A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist