Provider Demographics
NPI:1053523100
Name:FARMACIA DE MARIANAS
Entity type:Organization
Organization Name:FARMACIA DE MARIANAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA LUZ
Authorized Official - Middle Name:BALUYOT
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED PHARMACIS
Authorized Official - Phone:671-646-9696
Mailing Address - Street 1:PO BOX 8718
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96932
Mailing Address - Country:US
Mailing Address - Phone:671-646-9696
Mailing Address - Fax:671-649-6601
Practice Address - Street 1:543 CHALAN GUMAYUOS
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-9696
Practice Address - Fax:671-649-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUPCY004333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5410713OtherNCPDP NABP