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General NPI Number Information
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NPI Number | 1013934876
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Entity Type | Organization
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Legal Business Name | MARI-MINA PHARMACEUTICALS INC
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/20/2017
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Provider Practice Location Address
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Address Line | 10700 JERSEY BLVD 330-340
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5116
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Country | US
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Telephone | 909-948-0206
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Fax | 909-948-0075
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Provider Business Mailing Address
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Address Line | 10700 JERSEY BLVD 330-340
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5116
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Country | US
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Telephone | 909-948-0206
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Fax | 909-948-0075
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Authorized Official
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Title or Position | PRESIDENT
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Name | SAMEH ROKES
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Credential | RPH
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Telephone | 909-465-9282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | PHY49807
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License Number State | CA
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