Provider Demographics
NPI:1881992287
Name:BARNES, MARK LOREN (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LOREN
Last Name:BARNES
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 1:201 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-9493
Mailing Address - Country:US
Mailing Address - Phone:269-857-2300
Mailing Address - Fax:269-857-1874
Practice Address - Street 1:201 BUTLER ST
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-9493
Practice Address - Country:US
Practice Address - Phone:269-857-2300
Practice Address - Fax:269-857-1874
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410934183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist