Healthcare Provider Details

I. General information

NPI: 1003206517
Provider Name (Legal Business Name): MS. ELIZABETH MEBUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2015
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 FLANDERS RD
BURLINGTON NJ
08016-2813
US

IV. Provider business mailing address

413 FLANDERS RD
BURLINGTON NJ
08016-2813
US

V. Phone/Fax

Practice location:
  • Phone: 757-515-8587
  • Fax:
Mailing address:
  • Phone: 757-515-8587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number28RW02202100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: