Provider Demographics
NPI:1982952792
Name:LENIO, MARISSA LYNN
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:LYNN
Last Name:LENIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SAINT JAMES AVE
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2973
Mailing Address - Country:US
Mailing Address - Phone:843-572-1095
Mailing Address - Fax:843-863-1475
Practice Address - Street 1:142 SAINT JAMES AVE
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2973
Practice Address - Country:US
Practice Address - Phone:843-572-1095
Practice Address - Fax:843-863-1475
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2014-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12971183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist