Organization
MARIN WELLNESS PHARMACY, INC.
Active
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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