MEDICARE: MARISTE PHARMACEUTICALS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	27175	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2127032	OTHER		PK

General Provider Information

NPI Number	:	1013227149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARISTE PHARMACEUTICALS LLC

Provider Business Mailing Address
First Line	:	8433 FM 1464 RD STE G
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-1102
Country	:	US
Telephone Number	:	713-234-7190
Fax Number	:	713-234-7195

Provider Business Practice Location Address
First Line	:	8710 GRAND MISSION BLVD STE H
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-5413
Country	:	US
Telephone Number	:	713-234-7190
Fax Number	:	713-234-7195

Authorized Official
Title or Position	:	OWNER
Name	:	NKIRUKA OCHIBILI
Credential	:
Telephone Number	:	713-234-7190

Provider Enumeration Date	:	10/07/2010
Last Update Date	:	05/01/2017

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Directions to “MARISTE PHARMACEUTICALS LLC ” Practice Location

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