Healthcare Provider Details

I. General information

NPI: 1972085710
Provider Name (Legal Business Name): MARISSA PUC PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PERRY HWY
PITTSBURGH PA
15229-1820
US

IV. Provider business mailing address

1671 FRIAR TUCK DR
NORTH HUNTINGDON PA
15642-4403
US

V. Phone/Fax

Practice location:
  • Phone: 412-931-7751
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP452578
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: