Organization Active NPI

Palu Inc

Doing business as Marina Pharmacy

  • Community/Retail Pharmacy
  • Marina del Rey, CA
National Provider Identifier
1881611598
Registry record updated Sep 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
51786 Issued in CA
Legal business name
PALU INC
Doing business as
Marina Pharmacy
Practice address
4726 Lincoln Blvd
Marina del Rey, CA 90292-6902
Phone
(310) 301-4863
Fax
(310) 301-4865
NPI assigned
Jul 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nainala Srilakshmi
Title
Pic
Phone
(310) 301-4863

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 51786 CA Primary

Addresses

Primary practice location

4726 Lincoln Blvd
Marina del Rey, CA 90292-6902

Mailing address

4726 Lincoln Blvd
Marina del Rey, CA 90292-6902
Phone (310) 301-4863

Other identifiers 2

IdentifierTypeStateIssuer
0532463MedicaidCA
2144099OtherPK

Other names 1

  • Marina Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221109003313 CA Part B Supplier - Mass Immunization (Roster Biller Only) 4789082595 Practice locations: Marina del Rey, CA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory

Locations

4644 Lincoln Blvd
Ste 100
Marina del Rey, CA 90292

4726 Lincoln Blvd
Marina del Rey, CA 90292
Phone (310) 301-4863

4724 Lincoln Blvd
Marina del Rey, CA 90292
Phone (310) 301-4863

4644 Lincoln Blvd
Ste 103110
Marina del Rey, CA 90292

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1881611598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4726 LINCOLN BLVD",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926902",
            "telephone_number": "310-301-4863",
            "fax_number": "310-301-4865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4726 LINCOLN BLVD",
            "city": "MARINA DEL REY",
            "state": "CA",
            "postal_code": "902926902",
            "telephone_number": "310-301-4863",
            "fax_number": "310-301-4865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALU INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "SRILAKSHMI",
        "authorized_official_first_name": "NAINALA",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "310-301-4863"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "51786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0532463",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2144099",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marina Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Marina Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marina del Rey, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.