Provider Demographics
NPI:1831581958
Name:KORENNAYA, MARINA (PHARMD)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KORENNAYA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER RUN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-1501
Mailing Address - Country:US
Mailing Address - Phone:401-439-1981
Mailing Address - Fax:401-885-9887
Practice Address - Street 1:875 TIOGUE AVE
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-6300
Practice Address - Country:US
Practice Address - Phone:401-882-7602
Practice Address - Fax:401-882-7608
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRPH05249183500000X
MAPH234976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist