Healthcare Provider Details

I. General information

NPI: 1841123510
Provider Name (Legal Business Name): MARINA ISHAK
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 PGA BLVD
PALM BEACH GARDENS FL
33410-2758
US

IV. Provider business mailing address

3801 PGA BLVD
PALM BEACH GARDENS FL
33410-2758
US

V. Phone/Fax

Practice location:
  • Phone: 561-577-2750
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS55426
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: