Provider Demographics
NPI:1235721648
Name:ALFSON, MARIE E
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:ALFSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3318
Mailing Address - Country:US
Mailing Address - Phone:609-994-3588
Mailing Address - Fax:609-994-3706
Practice Address - Street 1:255 E BAY AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3318
Practice Address - Country:US
Practice Address - Phone:609-994-3588
Practice Address - Fax:609-994-3706
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03548100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist