Provider Demographics
NPI:1003179235
Name:LEARN, MARYBETH (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:LEARN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 BARTLEY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1166
Mailing Address - Country:US
Mailing Address - Phone:732-886-2410
Mailing Address - Fax:
Practice Address - Street 1:1691 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-1245
Practice Address - Country:US
Practice Address - Phone:732-914-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02088500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist