Basic Information
| Provider Information | |||||||||
| NPI: | 1659596203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRICE | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | D. | ||||||||
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| Credential: | RPH, CCP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 RAINBOW DR | ||||||||
| Address2: | |||||||||
| City: | SEWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080803054 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562569284 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 524 WILLIAMSTOWN RD | ||||||||
| Address2: | |||||||||
| City: | SICKLERVILLE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080811824 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8562629564 | ||||||||
| FaxNumber: | 8562620299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 28RI02436600 | NJ | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.