Provider Demographics
NPI:1346264926
Name:MAVROMATIS, MARINA (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:MAVROMATIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14540 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1616
Mailing Address - Country:US
Mailing Address - Phone:718-357-0144
Mailing Address - Fax:
Practice Address - Street 1:14540 6TH AVE
Practice Address - Street 2:
Practice Address - City:WHITESTONE
Practice Address - State:NY
Practice Address - Zip Code:11357-1616
Practice Address - Country:US
Practice Address - Phone:718-357-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047187-1183500000X
NJ28RI02603900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist