Provider Demographics
NPI:1194037804
Name:HOLBROOK, DANETTE RENEE (RPH, CCP, CIP)
Entity Type:Individual
Prefix:
First Name:DANETTE
Middle Name:RENEE
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:RPH, CCP, CIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 RASPBERRY LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-5703
Mailing Address - Country:US
Mailing Address - Phone:856-875-7095
Mailing Address - Fax:
Practice Address - Street 1:245 FRIES MILL RD STE A
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2059
Practice Address - Country:US
Practice Address - Phone:856-374-4066
Practice Address - Fax:856-274-4064
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02674300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist