Provider Demographics
NPI:1225305469
Name:FUSCO, MARIXA I (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARIXA
Middle Name:I
Last Name:FUSCO
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 1:1985 NE 119TH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3319
Mailing Address - Country:US
Mailing Address - Phone:305-893-8503
Mailing Address - Fax:
Practice Address - Street 1:1985 NE 119TH RD
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3319
Practice Address - Country:US
Practice Address - Phone:305-893-8503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist