Provider Demographics
NPI:1003907569
Name:MARIN, CARLOS M (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:M
Last Name:MARIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WESTOVER TER
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7722
Mailing Address - Country:US
Mailing Address - Phone:973-403-0263
Mailing Address - Fax:973-226-6796
Practice Address - Street 1:45 KULICK RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07004-3307
Practice Address - Country:US
Practice Address - Phone:973-575-0614
Practice Address - Fax:973-575-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01791500183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support