Provider Demographics
NPI:1609599216
Name:MARIANAS PHARMACY LLC
Entity Type:Organization
Organization Name:MARIANAS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER & MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:ATALIG
Authorized Official - Last Name:INOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:670-483-7802
Mailing Address - Street 1:PO BOX 10018 PMB 57
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-488-8324
Mailing Address - Fax:
Practice Address - Street 1:TOWNHOUSE SHOPPING CENTER. BEACH ROAD, CHALAN KANOA
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-488-8324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy