Provider Demographics
NPI:1710228515
Name:MAURICIO, CLARISSA (PHARM D)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:MAURICIO
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 1:401 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3711
Mailing Address - Country:US
Mailing Address - Phone:830-765-3607
Mailing Address - Fax:
Practice Address - Street 1:200 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-4658
Practice Address - Country:US
Practice Address - Phone:830-774-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist