Provider Demographics
NPI:1477228229
Name:PHARMACY AT THE REEF, LLC
Entity Type:Organization
Organization Name:PHARMACY AT THE REEF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:305-804-9970
Mailing Address - Street 1:31 OCEAN REEF DR STE A100
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-5281
Mailing Address - Country:US
Mailing Address - Phone:305-780-7136
Mailing Address - Fax:
Practice Address - Street 1:31 OCEAN REEF DR STE A100
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-5281
Practice Address - Country:US
Practice Address - Phone:305-780-7136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH33518OtherBOARD OF PHARMACY