Provider Demographics
NPI:1023379286
Name:MARIN PHARMACY LLC
Entity Type:Organization
Organization Name:MARIN PHARMACY LLC
Other - Org Name:MARIN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SAISATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-795-1795
Mailing Address - Street 1:1570-4 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4351
Mailing Address - Country:US
Mailing Address - Phone:212-795-1795
Mailing Address - Fax:212-740-7868
Practice Address - Street 1:1570-4 ST. NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4351
Practice Address - Country:US
Practice Address - Phone:212-795-1795
Practice Address - Fax:212-740-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03479490Medicaid
5805330OtherNCPDP PROVIDER IDENTIFICATION NUMBER