Individual
MR. MARK ELLIS SHAPIRO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
R.PH. B.SC.
Contact information
Practice address
100 ENTERTON RD, COSTCO PHARMACY DEPT. 749, MOUNT LAUREL, NJ 08054-6103
(856) 359-3678
(856) 359-3675
Mailing address
100 CENTERTON RD, MOUNT LAUREL, NJ 08054-6103
(856) 359-3678
(856) 359-5675
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI01767000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RI01767000
NEW JERSEY PHARMACIST LICENSE NUMBER
NJ
Enumeration date
10/15/2011
Last updated
10/15/2011
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