MEDICARE: MARVIN LIEBLEIN INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	333600000X	Pharmacy
2	3336C0003X	Community/Retail Pharmacy	50744	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2132765	OTHER		PK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073539532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARVIN LIEBLEIN INC

Provider Business Mailing Address
First Line	:	1400 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2013
Country	:	US
Telephone Number	:	562-591-4417
Fax Number	:	562-591-0416

Provider Business Practice Location Address
First Line	:	1400 ATLANTIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-2013
Country	:	US
Telephone Number	:	562-591-4417
Fax Number	:	562-591-0416

Authorized Official
Title or Position	:	OWNER
Name	:	JAYSHRI PATEL
Credential	:
Telephone Number	:	909-895-9260

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	09/02/2020

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Directions to “MARVIN LIEBLEIN INC ” Practice Location

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