Provider Demographics
NPI:1376763326
Name:MARINO, PETER JAMES (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:MARINO
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 QUEEN ANN RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-7943
Mailing Address - Country:US
Mailing Address - Phone:732-255-8902
Mailing Address - Fax:
Practice Address - Street 1:116 QUEEN ANN RD
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-7943
Practice Address - Country:US
Practice Address - Phone:732-255-8902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist