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General NPI Number Information
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NPI Number | 1366830291
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Entity Type | Organization
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Legal Business Name | MARIE MED CORP
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Dates
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Enumeration Date | 12/30/2014
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Last Update Date | 03/30/2020
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Provider Practice Location Address
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Address Line | 845 CARR 693 SUITE 14 PLAZA DORADA
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City | DORADO
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State | PR
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Zip | 00646-6708
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Country | US
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Telephone | 787-278-6300
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Fax | 787-278-6300
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Provider Business Mailing Address
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Address Line | 845 CARR 693 SUITE 14 PLAZA DORADA
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City | DORADO
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State | PR
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Zip | 00646-6708
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Country | US
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Telephone | 787-278-6300
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Fax | 787-278-6300
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIELA VAZQUEZ
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Credential | PHARMACIST
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Telephone | 787-278-6300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 16F3245
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License Number State | PR
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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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