Provider Demographics
NPI:1710603451
Name:GENDY, MARIANA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:GENDY
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 18TH ST N APT 305
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-1595
Mailing Address - Country:US
Mailing Address - Phone:201-539-1080
Mailing Address - Fax:
Practice Address - Street 1:1615 18TH ST N APT 305
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-1595
Practice Address - Country:US
Practice Address - Phone:201-539-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202220432183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist