Provider Demographics
NPI:1649531666
Name:DEFURE, ROBIN B (RP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:B
Last Name:DEFURE
Suffix:
Gender:F
Credentials:RP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:345 ROBERTS AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08752-2044
Mailing Address - Country:US
Mailing Address - Phone:732-793-6341
Mailing Address - Fax:
Practice Address - Street 1:1256 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-4075
Practice Address - Country:US
Practice Address - Phone:732-505-6446
Practice Address - Fax:732-349-6318
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01528500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4412702Medicaid