Provider Demographics
NPI:1295152759
Name:WAINWRIGHT, MARVIN JR (RPH)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:
Last Name:WAINWRIGHT
Suffix:JR
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 1:5 WILKINS STATION RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9606
Mailing Address - Country:US
Mailing Address - Phone:609-975-8197
Mailing Address - Fax:609-975-8223
Practice Address - Street 1:5 WILKINS STATION RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9606
Practice Address - Country:US
Practice Address - Phone:609-975-8197
Practice Address - Fax:609-975-8223
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI024224183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ28RI024224OtherNJ STATE LICENSE