Provider Demographics
NPI:1841528759
Name:CHAPA, MARISSA ANNETTE (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:ANNETTE
Last Name:CHAPA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MISS
Other - First Name:MARISSA
Other - Middle Name:ANNETTE
Other - Last Name:ESCALANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:111 PARKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-3536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10673 CULEBRA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1346
Practice Address - Country:US
Practice Address - Phone:210-647-9842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist