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General NPI Number Information
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NPI Number | 1417498841
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Entity Type | Individual
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Provider Name | MARK CHURCH PHARMD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2017
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Last Update Date | 03/18/2017
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Provider Practice Location Address
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Address Line | 677 CROSS KEYS RD
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-9564
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Country | US
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Telephone | 856-629-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 339 W RED BANK AVE
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City | WEST DEPTFORD
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State | NJ
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Zip | 08096-1417
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Country | US
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Telephone | 856-236-5250
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03724000
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License Number State | NJ
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