Healthcare Provider Details

I. General information

NPI: 1093695702
Provider Name (Legal Business Name): MARISSA CANTU PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 S MONACO PKWY UNIT 10
DENVER CO
80224-1635
US

IV. Provider business mailing address

1050 S MONACO PKWY UNIT 10
DENVER CO
80224-1635
US

V. Phone/Fax

Practice location:
  • Phone: 720-596-9500
  • Fax:
Mailing address:
  • Phone: 720-596-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number14095
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: