Provider Demographics
NPI:1659621969
Name:OSTROFF, MARISSA LYNN (PHARM,D)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:LYNN
Last Name:OSTROFF
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 1:9 GATEHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1922
Mailing Address - Country:US
Mailing Address - Phone:860-916-3451
Mailing Address - Fax:
Practice Address - Street 1:2150 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-3566
Practice Address - Country:US
Practice Address - Phone:860-916-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012379183500000X
MAPH235289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist