Marimina LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

MARIMINA LLC

Doing business as

Port Orange Pharmacy

Practice address

5820 S Williamson Blvd Ste 2
Port Orange, FL 32128-6401

Phone

(386) 212-0591

NPI assigned

Mar 12, 2018

Organization subpart

No

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

Authorized official

Name

Dimetry Ghabras

Title

Pharmacy Manager

Phone

(386) 212-0591

Specialties & licenses 1

Addresses

Other names 1

• Port Orange Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Networks

• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)
• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…

Practitioners 1

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

• David Michel Iskandar

  • Pharmacist
  • Port Orange, FL
  • NPI 1013684000
  NPD

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

{
    "created_epoch": "1520812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755129600000",
    "number": "1932602372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5820 S WILLIAMSON BLVD STE 2",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286401",
            "telephone_number": "386-366-8888",
            "fax_number": "386-366-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5820 S WILLIAMSON BLVD STE 2",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321286401",
            "telephone_number": "386-212-0591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIMINA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-12",
        "last_updated": "2025-08-14",
        "certification_date": "2025-08-14",
        "status": "A",
        "authorized_official_last_name": "GHABRAS",
        "authorized_official_first_name": "DIMETRY",
        "authorized_official_title_or_position": "PHARMACY MANAGER",
        "authorized_official_telephone_number": "386-212-0591"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Orange Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anthony Manzolillo
• Jamie Marando, HIS
• Marilyn Marchese, LMHC
• Jeanna Katherine Marcussen
• Shirley Marhofer
• Veronica Michelle Marin, DC
• Mark Dees Enterprises Inc. (Amada Senior Care of Daytona Beach)
• Sarah Tina Marks
• Candice Marois, ARNP, FNP-BC
• Jasmine M Marsden, RMFTI

• Community/Retail Pharmacy in Port Orange, FL
• Providers in Port Orange, 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 Aug 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.