Provider Demographics
NPI:1245553320
Name:PRICE, MARK BRIAN (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:BRIAN
Last Name:PRICE
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 1:85 MARIA DR
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-1344
Mailing Address - Country:US
Mailing Address - Phone:917-750-4464
Mailing Address - Fax:
Practice Address - Street 1:85 MARIA DR
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-1344
Practice Address - Country:US
Practice Address - Phone:917-750-4464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0342321183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist