Marin Wellness Pharmacy, Inc.

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

53342 Issued in CA

Legal business name

MARIN WELLNESS PHARMACY, INC.

Practice address

55 Mitchell Blvd Ste 11
San Rafael, CA 94903-2010

Phone

(415) 521-1555

Fax

(415) 299-8619

NPI assigned

Jun 17, 2015

Organization subpart

No

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

Authorized official

Name

Moussie Hailemariam

Title

President

Phone

(707) 953-4528

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Marin Wellness Pharmacy Doing business as

Tax ID family

Marin Wellness Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Marin Wellness Pharmacy LLC

  • Community/Retail Pharmacy
  • Rohnert Park, CA
  • NPI 1629871637
  NPD tax ID

Locations

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731974400000",
    "number": "1972984722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 MITCHELL BLVD",
            "address_2": "SUITE 11",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032082",
            "telephone_number": "415-521-1555",
            "fax_number": "415-299-8619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 MITCHELL BLVD STE 11",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032010",
            "telephone_number": "415-521-1555",
            "fax_number": "415-299-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIN WELLNESS PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-17",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A",
        "authorized_official_last_name": "HAILEMARIAM",
        "authorized_official_first_name": "MOUSSIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-953-4528"
    },
    "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": "53342",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152573",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marin Wellness Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Shira Marin, PHD, LMFT
• Marindale Medical Therapy Unit
• Marinidence Opco, LLC
• Marion Kregeloh
• Drew E Maris

• Community/Retail Pharmacy in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Community/Retail Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.