Provider Demographics
NPI:1407184633
Name:MARRERO, ALIDA GRISELLE (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ALIDA
Middle Name:GRISELLE
Last Name:MARRERO
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 VIA GRANDE
Mailing Address - Street 2:HACIENDA SAN JOSE
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3067
Mailing Address - Country:US
Mailing Address - Phone:787-616-0105
Mailing Address - Fax:
Practice Address - Street 1:HACIENDA SAN JOSE 101 ASOMANTE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-616-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0053531835P0018X, 1835P1200X
FL31109781835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist