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General NPI Number Information
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NPI Number | 1558876094
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Entity Type | Organization
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Legal Business Name | MARINE PARK LLC
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 3514 BROADWAY
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-2332
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Country | US
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Telephone | 561-782-7575
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Fax | 855-230-7564
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Provider Business Mailing Address
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Address Line | 3514 BROADWAY
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City | RIVIERA BEACH
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State | FL
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Zip | 33404-2332
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Country | US
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Telephone | 561-782-7575
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Fax | 855-230-7564
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Authorized Official
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Title or Position | MGR
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Name | DIANA VANESSA RODRIGUEZ
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Credential |
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Telephone | 954-552-2242
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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 | PH31059
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License Number State | FL
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