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General NPI Number Information
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NPI Number | 1609466671
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Entity Type | Organization
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Legal Business Name | VIBRANT HYDRATION & WELLNESS
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Dates
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Enumeration Date | 01/22/2021
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 812 REGAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5603
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Country | US
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Telephone | 256-964-8177
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Fax |
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Provider Business Mailing Address
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Address Line | 812 REGAL DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-5603
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Country | US
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Telephone | 256-964-8177
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIUS MARIN
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Credential | PHARMD
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Telephone | 256-738-7292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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