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General NPI Number Information
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NPI Number | 1225073083
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Entity Type | Organization
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Legal Business Name | MARIOMINA INC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 01/18/2017
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Provider Practice Location Address
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Address Line | 820 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91722-3622
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Country | US
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Telephone | 626-446-6088
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Fax | 626-446-9399
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Provider Business Mailing Address
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Address Line | 820 W SAN BERNARDINO RD
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City | COVINA
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State | CA
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Zip | 91722-3622
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Country | US
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Telephone | 626-446-6088
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Fax | 626-446-9399
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Authorized Official
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Title or Position | PHARMACIST IN CHARGE
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Name | MAGED BESHAY
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Credential |
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Telephone | 909-837-8560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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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 | 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 #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PHY54605
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License Number State | CA
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