Provider Demographics
NPI:1114070844
Name:LEVINE, MARK D (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:LEVINE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 SAHALEE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4041
Mailing Address - Country:US
Mailing Address - Phone:732-928-0869
Mailing Address - Fax:609-758-8829
Practice Address - Street 1:28 BRINDLETOWN RD
Practice Address - Street 2:
Practice Address - City:NEW EGYPT
Practice Address - State:NJ
Practice Address - Zip Code:08533-1802
Practice Address - Country:US
Practice Address - Phone:609-758-8829
Practice Address - Fax:609-758-0678
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01411600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist