Provider Demographics
NPI:1164010294
Name:BARONE, DEBRA (RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BARONE
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 1:1584 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-2704
Mailing Address - Country:US
Mailing Address - Phone:732-551-0610
Mailing Address - Fax:
Practice Address - Street 1:1584 HORSESHOE DR
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2704
Practice Address - Country:US
Practice Address - Phone:732-551-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02205300183500000X
NJ28RI022054003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty