Provider Demographics
NPI:1760650329
Name:RABORN, ADINA IVY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ADINA
Middle Name:IVY
Last Name:RABORN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 PLANTATION RD
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3207
Mailing Address - Country:US
Mailing Address - Phone:908-534-8599
Mailing Address - Fax:
Practice Address - Street 1:315 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4627
Practice Address - Country:US
Practice Address - Phone:908-431-3070
Practice Address - Fax:908-431-4018
Is Sole Proprietor?:No
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02672100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI02672100OtherRPH