Provider Demographics
NPI:1851306468
Name:MARINO PHARMACY INC
Entity Type:Organization
Organization Name:MARINO PHARMACY INC
Other - Org Name:MARINO PHARMACY INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ALESSANDRI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-497-3104
Mailing Address - Street 1:167 WYCKOFF AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4303
Mailing Address - Country:US
Mailing Address - Phone:718-497-3104
Mailing Address - Fax:718-456-5141
Practice Address - Street 1:167 WYCKOFF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4303
Practice Address - Country:US
Practice Address - Phone:718-497-3104
Practice Address - Fax:718-456-5141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
NY0184333336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00268951Medicaid
2064095OtherPK
NY00268951Medicaid