MEDICARE: MARINO PHARMACY 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	3336C0004X	Compounding Pharmacy
3	3336C0003X	Community/Retail Pharmacy	018433	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2064095	OTHER		PK

General Provider Information

NPI Number	:	1851306468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARINO PHARMACY INC

Provider Business Mailing Address
First Line	:	167 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4303
Country	:	US
Telephone Number	:	718-497-3104
Fax Number	:	718-456-5141

Provider Business Practice Location Address
First Line	:	167 WYCKOFF AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4303
Country	:	US
Telephone Number	:	718-497-3104
Fax Number	:	718-456-5141

Authorized Official
Title or Position	:	OWNER
Name	:	ROBERT ALESSANDRI
Credential	:	RPH
Telephone Number	:	718-497-3104

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	12/29/2015

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