Provider Demographics
NPI:1366631129
Name:MARIN, ROBERT E (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:E
Last Name:MARIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 JERUSALEM AVE
Mailing Address - Street 2:
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553
Mailing Address - Country:US
Mailing Address - Phone:516-505-1230
Mailing Address - Fax:516-505-1235
Practice Address - Street 1:1153 JERUSALEM AVE
Practice Address - Street 2:
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553
Practice Address - Country:US
Practice Address - Phone:516-505-1230
Practice Address - Fax:516-505-1235
Is Sole Proprietor?:No
Enumeration Date:2007-10-17
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01790385Medicaid