Provider Demographics
NPI:1568662401
Name:BECERRA, MARITZA (RPHARM)
Entity Type:Individual
Prefix:MS
First Name:MARITZA
Middle Name:
Last Name:BECERRA
Suffix:
Gender:F
Credentials:RPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 W ESTRELLA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6120
Mailing Address - Country:US
Mailing Address - Phone:813-254-0632
Mailing Address - Fax:
Practice Address - Street 1:2804 W ESTRELLA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6120
Practice Address - Country:US
Practice Address - Phone:813-254-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL022819183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist