Healthcare Provider Details

I. General information

NPI: 1033794615
Provider Name (Legal Business Name): MARVEL PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15246 SATICOY ST
VAN NUYS CA
91405-1623
US

IV. Provider business mailing address

15246 SATICOY ST
VAN NUYS CA
91405-1623
US

V. Phone/Fax

Practice location:
  • Phone: 818-806-0205
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: YEVGENIYA GABRIYELOVA
Title or Position: OWNER
Credential:
Phone: 818-806-0205