Provider Demographics
NPI:1275633448
Name:MARIE MED CORP.
Entity type:Organization
Organization Name:MARIE MED CORP.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:787-278-6300
Mailing Address - Street 1:845 CARR 693 SUITE 14
Mailing Address - Street 2:PLAZA DORADA
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-272-4998
Mailing Address - Fax:787-272-4969
Practice Address - Street 1:CARR 177 KM 2 0 LOS FILTROS
Practice Address - Street 2:AVE CASA LINDA #1 SUITE 101
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-272-4998
Practice Address - Fax:787-272-4969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4023583OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5596330001Medicare NSC