Organization
MARIN WELLNESS PHARMACY, INC.
Active
Other names
Marin Wellness Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
MOUSSIE HAILEMARIAM (PRESIDENT)
(707) 953-4528
Entity
Organization
Contact information
Practice address
55 MITCHELL BLVD STE 11, SAN RAFAEL, CA 94903-2010
(415) 521-1555
(415) 299-8619
Mailing address
55 MITCHELL BLVD, SUITE 11, SAN RAFAEL, CA 94903-2082
(415) 521-1555
(415) 299-8619
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
53342
CA
3336C0004X
Compounding Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2152573
PK
—
Enumeration date
06/17/2015
Last updated
11/19/2024
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