Provider Demographics
NPI:1154905560
Name:MARRAS PHARMA CORP
Entity type:Organization
Organization Name:MARRAS PHARMA CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:PRAVEEN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:CHALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:518-237-2110
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-0229
Mailing Address - Country:US
Mailing Address - Phone:518-237-2110
Mailing Address - Fax:
Practice Address - Street 1:217 REMSEN ST
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-3024
Practice Address - Country:US
Practice Address - Phone:518-237-2110
Practice Address - Fax:518-237-5513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-11
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY038698OtherNY STATE LICENSE