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General NPI Number Information
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NPI Number | 1518003136
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Entity Type | Organization
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Legal Business Name | MARIANO PRIME LIMITED LIABILITY
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 02/21/2017
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Provider Practice Location Address
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Address Line | 330 W MARINE CORPS DR
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City | DEDEDO
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State | GU
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Zip | 96929-5924
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Country | US
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Telephone | 671-632-3385
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Fax | 671-623-3528
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Provider Business Mailing Address
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Address Line | 255 FARENHOLT AVE
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City | TAMUNING
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State | GU
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Zip | 96913-3209
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Country | US
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Telephone | 671-632-3385
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Fax | 671-623-3528
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Authorized Official
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Title or Position | OWNER
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Name | ARTHUR MARIANO
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Credential |
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Telephone | 671-646-0020
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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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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PCY040
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License Number State | GU
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