Healthcare Provider Details

I. General information

NPI: 1811699309
Provider Name (Legal Business Name): MARISSA JACQUELINE MAURICIO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 07/09/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 COMMERCE WAY
MIAMI LAKES FL
33016-1508
US

IV. Provider business mailing address

14400 COMMERCE WAY MIAMI
MIAMI FL
33016-4165
US

V. Phone/Fax

Practice location:
  • Phone: 210-630-9175
  • Fax:
Mailing address:
  • Phone: 210-630-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS65135
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPU9576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: