Provider Demographics
NPI:1720301500
Name:GRUN, MARC (RPH)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:GRUN
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 1:20 POST LN N
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-6729
Mailing Address - Country:US
Mailing Address - Phone:845-228-8924
Mailing Address - Fax:
Practice Address - Street 1:20 POST LN N
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6729
Practice Address - Country:US
Practice Address - Phone:845-228-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31676183500000X
NJ28RI01867000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist