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General NPI Number Information
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NPI Number | 1710202874
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Entity Type | Organization
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Legal Business Name | MARIANNA'S PHARMACY COPR
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Dates
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Enumeration Date | 04/01/2010
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Last Update Date | 04/01/2010
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Provider Practice Location Address
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Address Line | 1301 AVE U
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City | BROOKLYN
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State | NY
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Zip | 11229
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Country | US
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Telephone | 718-676-1516
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Fax | 718-676-1521
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Provider Business Mailing Address
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Address Line | 1301 AVE U
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City | BROOKLYN
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State | NY
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Zip | 11229
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Country | US
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Telephone | 718-676-1516
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Fax | 718-676-1521
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Authorized Official
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Title or Position | PHARMACIST/OWNER
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Name | MR. ALEX GELBINOVICH
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Credential | RPH
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Telephone | 718-676-1516
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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 | 029960
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License Number State | NY
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