MEDICARE: MARIAGROUPLLC

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

General Provider Information

NPI Number	:	1164860946
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIAGROUPLLC

Provider Business Mailing Address
First Line	:	15835 BEREA DR
Second Line	:
City	:	ODESSA
State	:	FL
Zip	:	33556-3041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6641 MADISON ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-1966
Country	:	US
Telephone Number	:	727-687-7500
Fax Number	:	727-845-8008

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MAYA JOMON ANTONY
Credential	:
Telephone Number	:	727-687-7500

Provider Enumeration Date	:	06/13/2013
Last Update Date	:	06/13/2013

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Directions to “MARIAGROUPLLC ” Practice Location

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