Provider Demographics
NPI:1881866408
Name:MARVA HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:MARVA HEALTH SERVICES LLC
Other - Org Name:POCOMOKE DISCOUNT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZAHEER
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:410-430-5530
Mailing Address - Street 1:305 10TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:POCOMOKE CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1607
Mailing Address - Country:US
Mailing Address - Phone:410-957-9030
Mailing Address - Fax:410-957-9033
Practice Address - Street 1:305 10TH ST
Practice Address - Street 2:STE 103
Practice Address - City:POCOMOKE CITY
Practice Address - State:MD
Practice Address - Zip Code:21851-1607
Practice Address - Country:US
Practice Address - Phone:410-957-9030
Practice Address - Fax:410-957-9033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDP047423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2038351OtherPK
MD414749900Medicaid