Provider Demographics
NPI:1992380208
Name:BAKMAN, IRINA (RPH)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:BAKMAN
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 1:700 TENNENT RD STE 9
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3148
Mailing Address - Country:US
Mailing Address - Phone:732-851-7100
Mailing Address - Fax:
Practice Address - Street 1:700 TENNENT RD STE 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3148
Practice Address - Country:US
Practice Address - Phone:732-851-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02573300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist