Provider Demographics
NPI:1659596203
Name:PRICE, MARK D (RPH, CCP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:PRICE
Suffix:
Gender:M
Credentials:RPH, CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3054
Mailing Address - Country:US
Mailing Address - Phone:856-256-9284
Mailing Address - Fax:
Practice Address - Street 1:524 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1824
Practice Address - Country:US
Practice Address - Phone:856-262-9564
Practice Address - Fax:856-262-0299
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02436600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist