Healthcare Provider Details

I. General information

NPI: 1831449107
Provider Name (Legal Business Name): MARI-MINA PHARMACEUTICALS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 BUENA VISTA ST STE 104
DUARTE CA
91010-1780
US

IV. Provider business mailing address

931 BUENA VISTA ST SUITE 104
DUARTE CA
91010-1712
US

V. Phone/Fax

Practice location:
  • Phone: 626-357-8500
  • Fax: 626-357-0119
Mailing address:
  • Phone: 626-357-8500
  • Fax: 626-357-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number50934
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SAMEH ROKES
Title or Position: PRESIDENT/PIC
Credential:
Phone: 626-357-8500