Provider Demographics
NPI:1629871637
Name:MARIN WELLNESS PHARMACY LLC
Entity type:Organization
Organization Name:MARIN WELLNESS PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MOUSSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAILEMARIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-953-4528
Mailing Address - Street 1:3299 E HILL ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-1231
Mailing Address - Country:US
Mailing Address - Phone:415-521-1555
Mailing Address - Fax:
Practice Address - Street 1:170 PROFESSIONAL CENTER DR STE C
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2169
Practice Address - Country:US
Practice Address - Phone:707-953-4528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIN WELLNESS PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-03-27
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy