Provider Demographics
NPI:1871912675
Name:MAYERSON, MARVIN E (RPH)
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:E
Last Name:MAYERSON
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 1:11 ELLSWORTH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MONTVALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07645
Mailing Address - Country:US
Mailing Address - Phone:201-573-0063
Mailing Address - Fax:201-573-0063
Practice Address - Street 1:11 ELLSWORTH TERRACE
Practice Address - Street 2:
Practice Address - City:MONTVALE
Practice Address - State:NJ
Practice Address - Zip Code:07645
Practice Address - Country:US
Practice Address - Phone:201-573-0063
Practice Address - Fax:201-573-0063
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01157000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist