Provider Demographics
NPI:1043504269
Name:MARRERO-BAUZA, VIVIENNE MARIE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:VIVIENNE
Middle Name:MARIE
Last Name:MARRERO-BAUZA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0445
Mailing Address - Country:US
Mailing Address - Phone:787-718-9153
Mailing Address - Fax:
Practice Address - Street 1:PLAZA JUANA DIAZ CARRETERA 149
Practice Address - Street 2:INTERSECCION CARRETERA 584 Y 52
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-0000
Practice Address - Country:US
Practice Address - Phone:787-837-7090
Practice Address - Fax:787-837-7090
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist