Provider Demographics
NPI:1518567924
Name:DAVIDSON, MARISSA APRIL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:APRIL
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6022 CAPROCK CT APT 1402
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3935
Mailing Address - Country:US
Mailing Address - Phone:915-401-9271
Mailing Address - Fax:
Practice Address - Street 1:1110 SUNLAND PARK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1379
Practice Address - Country:US
Practice Address - Phone:915-308-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67226183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist