MEDICARE: MARINA TYAN

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	183500000X	Pharmacist	064970	NY

General Provider Information

NPI Number	:	1376120949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA TYAN

Provider Business Mailing Address
First Line	:	2035 E 7TH ST APT 3F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-3125
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 PARK PL
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11217-3350
Country	:	US
Telephone Number	:	718-857-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2021
Last Update Date	:	01/06/2026

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Directions to “ MARINA TYAN ” Practice Location

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