Provider Demographics
NPI:1518000975
Name:RODRIGUEZ, MARISSA S (RPH, PHC)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:S
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPH, PHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12405 RAINIER WAY NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7272
Mailing Address - Country:US
Mailing Address - Phone:505-296-2549
Mailing Address - Fax:505-291-2233
Practice Address - Street 1:8300 CONSTITUTION AVE NE BLDG D
Practice Address - Street 2:PRESBYTERIAN MEDICAL GROUP
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2200
Practice Address - Fax:505-291-2233
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5808183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPC00000088OtherPHARMACIST CLINICIAN
NMRP00005808OtherREGISTERED PHARMACIST