Provider Demographics
NPI:1679854368
Name:VAYNERCHUK, GENE (RPH)
Entity Type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:VAYNERCHUK
Suffix:
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 1:57 MEADOWLARK RD
Mailing Address - Street 2:
Mailing Address - City:WATCHUNG
Mailing Address - State:NJ
Mailing Address - Zip Code:07069-6020
Mailing Address - Country:US
Mailing Address - Phone:908-237-0244
Mailing Address - Fax:908-237-9240
Practice Address - Street 1:29 ROUTE 31
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1634
Practice Address - Country:US
Practice Address - Phone:908-237-0244
Practice Address - Fax:908-237-9240
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02463100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist