MEDICARE: MARIOMINA 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	3336L0003X	Long Term Care Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	3336C0003X	Community/Retail Pharmacy	PHY54605	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2113683	OTHER		PK

General Provider Information

NPI Number	:	1225073083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIOMINA INC

Provider Business Mailing Address
First Line	:	820 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3622
Country	:	US
Telephone Number	:	626-446-6088
Fax Number	:	626-446-9399

Provider Business Practice Location Address
First Line	:	820 W SAN BERNARDINO RD
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91722-3622
Country	:	US
Telephone Number	:	626-446-6088
Fax Number	:	626-446-9399

Authorized Official
Title or Position	:	PHARMACIST IN CHARGE
Name	:	MAGED BESHAY
Credential	:
Telephone Number	:	909-837-8560

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	01/18/2017

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Directions to “MARIOMINA INC ” Practice Location

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