Provider Demographics
NPI:1902179740
Name:MARIARX INC
Entity Type:Organization
Organization Name:MARIARX INC
Other - Org Name:MARIA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-554-4754
Mailing Address - Street 1:13872 HARBOR BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4000
Mailing Address - Country:US
Mailing Address - Phone:714-554-4754
Mailing Address - Fax:714-554-4854
Practice Address - Street 1:13872 HARBOR BLVD STE 1A
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4000
Practice Address - Country:US
Practice Address - Phone:714-554-4754
Practice Address - Fax:714-554-4854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY58863OtherBOARD OF PHARMACY