Provider Demographics
NPI:1154921948
Name:RENTERIA, MARISA CALVILLO (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:CALVILLO
Last Name:RENTERIA
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 SAIL LOFT CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78242-2928
Mailing Address - Country:US
Mailing Address - Phone:210-544-2398
Mailing Address - Fax:
Practice Address - Street 1:5626 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2105
Practice Address - Country:US
Practice Address - Phone:210-507-0652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist