Marietta Pharmacy LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PH26285 Issued in FL

Legal business name

MARIETTA PHARMACY LLC

Doing business as

Marietta Pharmacy

Practice address

8299 W Beaver St Ste 5
Jacksonville, FL 32220-2315

Phone

(904) 999-4884

Fax

(904) 999-4883

NPI assigned

Jul 31, 2012

Last updated

Feb 24, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Hanesh Patel

Title

RXM

Phone

(904) 999-4884

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• MARIETTA PHARMACY Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Azeb Muluneh, PHARMD

  • Pharmacist
  • Melbourne, FL
  • NPI 1083112064
  NPD (past)

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

{
    "created_epoch": "1343692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645660800000",
    "number": "1912253774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8299 W BEAVER ST STE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322202315",
            "telephone_number": "904-999-4884",
            "fax_number": "904-999-4883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8299 W BEAVER ST STE 5",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322202315",
            "telephone_number": "904-999-4884",
            "fax_number": "904-999-4883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA PHARMACY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-31",
        "last_updated": "2022-02-24",
        "certification_date": "2022-02-24",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "HANESH",
        "authorized_official_title_or_position": "RXM",
        "authorized_official_telephone_number": "904-999-4884"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": "PH26285",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007212200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5711189",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARIETTA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MARIETTA PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marian Lavonne Jones (Jones, AFCH)
• Erika Maribona
• Manuel Marichal
• Eduardo J Mariel, M.D.
• Marietta Dental Group
• Erick Momanyi Marigi, MD
• Marigold Family Care LLC
• Iris Marin Collazo, MD
• Gredymar Patricia Marin Tovar, MD
• Stefana Marin-Danciu

• Community/Retail Pharmacy in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Community/Retail Pharmacy in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.