Provider Demographics
NPI:1275188781
Name:KITAJIMA, MARISSA GUTIERREZ (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:GUTIERREZ
Last Name:KITAJIMA
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 1:4370 EASTGATE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-4502
Mailing Address - Country:US
Mailing Address - Phone:513-753-3370
Mailing Address - Fax:513-753-3973
Practice Address - Street 1:4370 EASTGATE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-4502
Practice Address - Country:US
Practice Address - Phone:513-753-3370
Practice Address - Fax:513-753-3973
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03334211183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist