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General NPI Number Information
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NPI Number | 1932602372
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Entity Type | Organization
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Legal Business Name | MARIMINA LLC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 5820 S WILLIAMSON BLVD STE 2
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City | PORT ORANGE
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State | FL
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Zip | 32128-6401
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Country | US
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Telephone | 386-212-0591
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Fax |
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Provider Business Mailing Address
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Address Line | 5820 S WILLIAMSON BLVD STE 2
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City | PORT ORANGE
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State | FL
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Zip | 32128-6401
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Country | US
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Telephone | 386-366-8888
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Fax | 386-366-8644
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DIMETRY GHABRAS
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Credential |
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Telephone | 386-212-0591
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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 |
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License Number State | FL
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