Provider Demographics
NPI:1629832365
Name:MARANATHA PHARMACY SERVICES
Entity Type:Organization
Organization Name:MARANATHA PHARMACY SERVICES
Other - Org Name:TRANSFORMATIONAL PHARMACY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JOSUEE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MERTYL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:888-344-4549
Mailing Address - Street 1:123 HIGHLAND AVE STE G2-B
Mailing Address - Street 2:
Mailing Address - City:GLEN RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07028-1527
Mailing Address - Country:US
Mailing Address - Phone:888-344-4549
Mailing Address - Fax:908-652-9230
Practice Address - Street 1:123 HIGHLAND AVE STE G2-B
Practice Address - Street 2:
Practice Address - City:GLEN RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07028-1527
Practice Address - Country:US
Practice Address - Phone:888-344-4549
Practice Address - Fax:908-652-9230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy