Healthcare Provider Details

I. General information

NPI: 1356971683
Provider Name (Legal Business Name): MARISSA YU PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2020
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4260 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

IV. Provider business mailing address

4260 PLYMOUTH RD
ANN ARBOR MI
48109-2700
US

V. Phone/Fax

Practice location:
  • Phone: 734-647-5707
  • Fax: 734-647-6459
Mailing address:
  • Phone: 734-647-5705
  • Fax: 734-647-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040891
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: