Active NPI
Marissa Roque Ridao-Robertson, RPH
- Pharmacist
- Palo Alto, CA
National Provider Identifier
1780106252
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 72601
- Practice address
- 855 El Camino Real
Palo Alto, CA 94301-2305 - Phone
- (650) 322-2554
- NPI assigned
- Jul 16, 2017
- Last updated
- Jun 16, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 72601 | CA | Primary |
Addresses
Primary practice location
855 El Camino Real
Palo Alto, CA 94301-2305
Mailing address
5211 Amberwood Dr
Fremont, CA 94555-3856
Phone (510) 241-8613
Other names 1
- Marissa Roque Ridao
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 72601 | CA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Longs Drug Store California LLC | Past | Accepting new patients | |
| Longs Drug Stores California LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1780106252",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5211 AMBERWOOD DR",
"city": "FREMONT",
"state": "CA",
"postal_code": "945553856",
"telephone_number": "510-241-8613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "855 EL CAMINO REAL",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "943012305",
"telephone_number": "650-322-2554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDAO-ROBERTSON",
"first_name": "MARISSA",
"middle_name": "ROQUE",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-07-16",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "72601",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARISSA",
"last_name": "RIDAO",
"middle_name": "ROQUE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.