Provider Demographics
NPI:1821483074
Name:GRUEN, MARIYA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:GRUEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 92ND ST
Mailing Address - Street 2:
Mailing Address - City:SURFSIDE
Mailing Address - State:FL
Mailing Address - Zip Code:33154-3007
Mailing Address - Country:US
Mailing Address - Phone:954-256-6028
Mailing Address - Fax:
Practice Address - Street 1:301 92ND ST
Practice Address - Street 2:
Practice Address - City:SURFSIDE
Practice Address - State:FL
Practice Address - Zip Code:33154-3007
Practice Address - Country:US
Practice Address - Phone:954-256-6028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42484183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist