Provider Demographics
NPI:1366830291
Name:MARIE MED CORP
Entity Type:Organization
Organization Name:MARIE MED CORP
Other - Org Name:MARIE MED CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
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:00646-6708
Mailing Address - Country:US
Mailing Address - Phone:787-278-6300
Mailing Address - Fax:787-278-6300
Practice Address - Street 1:845 CARR 693 SUITE 14
Practice Address - Street 2:PLAZA DORADA
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-6708
Practice Address - Country:US
Practice Address - Phone:787-278-6300
Practice Address - Fax:787-278-6300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16F32453336C0003X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy