Provider Demographics
NPI:1114195799
Name:VANOVER, DEAN J
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:J
Last Name:VANOVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 ENTERPRISE DR
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-1815
Mailing Address - Country:US
Mailing Address - Phone:732-974-9290
Mailing Address - Fax:732-974-5590
Practice Address - Street 1:2007 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07719-3543
Practice Address - Country:US
Practice Address - Phone:732-974-9290
Practice Address - Fax:732-974-5590
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01572500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI01572500OtherSTATE LICENSE NUMBER