Provider Demographics
NPI:1225206014
Name:DEVOS, MARINUS
Entity Type:Individual
Prefix:MR
First Name:MARINUS
Middle Name:
Last Name:DEVOS
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 1:35 COLLURA LN
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1661
Mailing Address - Country:US
Mailing Address - Phone:973-472-6809
Mailing Address - Fax:
Practice Address - Street 1:35 COLLURA LANE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1661
Practice Address - Country:US
Practice Address - Phone:973-472-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02412100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist