Provider Demographics
NPI:1326762386
Name:PASQUALETTI, MARISSA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:
Last Name:PASQUALETTI
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 1:599 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1631
Mailing Address - Country:US
Mailing Address - Phone:815-573-2886
Mailing Address - Fax:
Practice Address - Street 1:279 IL-115
Practice Address - Street 2:
Practice Address - City:HERSCHER
Practice Address - State:IL
Practice Address - Zip Code:60950-6095
Practice Address - Country:US
Practice Address - Phone:815-421-0244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051294386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist