Provider Demographics
NPI:1245342179
Name:MARANDO INC
Entity type:Organization
Organization Name:MARANDO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-432-2092
Mailing Address - Street 1:5507 N W ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32505-2435
Mailing Address - Country:US
Mailing Address - Phone:850-432-2092
Mailing Address - Fax:850-436-4033
Practice Address - Street 1:5507 N W ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32505-2435
Practice Address - Country:US
Practice Address - Phone:850-432-2092
Practice Address - Fax:850-436-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0009792333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered333600000XSuppliersPharmacy
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10510900Medicaid
1046083OtherOTHER ID NUMBER-COMMERCIAL NUMBER
0311780001Medicare ID - Type Unspecified