Provider Demographics
NPI:1740567387
Name:GREENBERG, MARC (RPH)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GREENBERG
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 1:47 SWEETBRIAR TRL
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2260
Mailing Address - Country:US
Mailing Address - Phone:732-938-3956
Mailing Address - Fax:
Practice Address - Street 1:47 SWEETBRIAR TRL
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2260
Practice Address - Country:US
Practice Address - Phone:732-938-3956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02147300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist