Provider Demographics
NPI:1407407737
Name:MARIANO PRIME LLC
Entity Type:Organization
Organization Name:MARIANO PRIME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:SURLA
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:671-646-5355
Mailing Address - Street 1:255 FARENHOLT AVE
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3209
Mailing Address - Country:US
Mailing Address - Phone:671-646-5355
Mailing Address - Fax:671-646-5333
Practice Address - Street 1:548 S MARINE CORPS DR
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3539
Practice Address - Country:US
Practice Address - Phone:671-969-5900
Practice Address - Fax:671-969-2800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-27
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy