Provider Demographics
NPI:1225414865
Name:DEWDNEY, MARISSA MICHAELA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:MICHAELA
Last Name:DEWDNEY
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 1:2731 BLAIRSTONE RD APT 9
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-5908
Mailing Address - Country:US
Mailing Address - Phone:813-391-7660
Mailing Address - Fax:
Practice Address - Street 1:2731 BLAIRSTONE RD APT 9
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5908
Practice Address - Country:US
Practice Address - Phone:813-391-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53813183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist