1245515733 NPI number — MR. MARK ELLIS SHAPIRO R.PH. B.SC.

Table of content: MR. MARK ELLIS SHAPIRO R.PH. B.SC. (NPI 1245515733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245515733 NPI number — MR. MARK ELLIS SHAPIRO R.PH. B.SC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAPIRO
Provider First Name:
MARK
Provider Middle Name:
ELLIS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH. B.SC.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245515733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 CENTERTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-6103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-359-3678
Provider Business Mailing Address Fax Number:
856-359-5675

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ENTERTON RD
Provider Second Line Business Practice Location Address:
COSTCO PHARMACY DEPT. 749
Provider Business Practice Location Address City Name:
MOUNT LAUREL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08054-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-359-3678
Provider Business Practice Location Address Fax Number:
856-359-3675
Provider Enumeration Date:
10/15/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  28RI01767000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28RI01767000 . This is a "NEW JERSEY PHARMACIST LICENSE NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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