Healthcare Provider Details

I. General information

NPI: 1245743681
Provider Name (Legal Business Name): MARISSA CULLEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 12/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

IV. Provider business mailing address

3811 OHARA ST
PITTSBURGH PA
15213-2561
US

V. Phone/Fax

Practice location:
  • Phone: 412-624-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number03334750
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberRP451439
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: