Provider Demographics
NPI:1588833008
Name:RABORN, MARTIN L JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:L
Last Name:RABORN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 ROUTE 206
Mailing Address - Street 2:NORTH PATHMARK PHARMACY
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844
Mailing Address - Country:US
Mailing Address - Phone:908-431-3070
Mailing Address - Fax:907-431-4018
Practice Address - Street 1:315 ROUTE 206 NORTH
Practice Address - Street 2:PATHMARK PHARMACY
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844
Practice Address - Country:US
Practice Address - Phone:908-431-3070
Practice Address - Fax:907-431-4018
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02492400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist