Provider Demographics
NPI:1477873602
Name:MAR, VAN M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:M
Last Name:MAR
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 FLORIN RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3515
Mailing Address - Country:US
Mailing Address - Phone:916-422-7202
Mailing Address - Fax:916-422-0839
Practice Address - Street 1:980 FLORIN RD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3515
Practice Address - Country:US
Practice Address - Phone:916-422-7202
Practice Address - Fax:916-422-0839
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46256183500000X
NV11605183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist