Provider Demographics
NPI:1811699309
Name:MAURICIO, MARISSA JACQUELINE (PHARMD)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:JACQUELINE
Last Name:MAURICIO
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 1:14400 COMMERCE WAY
Mailing Address - Street 2:MIAMI
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33016-4165
Mailing Address - Country:US
Mailing Address - Phone:210-630-9175
Mailing Address - Fax:
Practice Address - Street 1:14400 COMMERCE WAY
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1508
Practice Address - Country:US
Practice Address - Phone:210-630-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS651351835P2201X
FLPU9576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
No183500000XPharmacy Service ProvidersPharmacist