Provider Demographics
NPI:1093311458
Name:HOOYMAN, MARY SUSAN (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUSAN
Last Name:HOOYMAN
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 1:9 STEVENS LN
Mailing Address - Street 2:
Mailing Address - City:TABERNACLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08088-9734
Mailing Address - Country:US
Mailing Address - Phone:732-691-9633
Mailing Address - Fax:
Practice Address - Street 1:860 FISCHER BLVD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3824
Practice Address - Country:US
Practice Address - Phone:732-270-0900
Practice Address - Fax:732-506-9347
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02487200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist