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General NPI Number Information
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NPI Number | 1164860946
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Entity Type | Organization
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Legal Business Name | MARIAGROUPLLC
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Dates
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Enumeration Date | 06/13/2013
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Last Update Date | 06/13/2013
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Provider Practice Location Address
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Address Line | 6641 MADISON ST
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-1966
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Country | US
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Telephone | 727-687-7500
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Fax | 727-845-8008
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Provider Business Mailing Address
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Address Line | 15835 BEREA DR
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City | ODESSA
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State | FL
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Zip | 33556-3041
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MAYA JOMON ANTONY
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Credential |
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Telephone | 727-687-7500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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