Individual
MARK CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
677 CROSS KEYS RD, SICKLERVILLE, NJ 08081-9564
(856) 629-0690
Mailing address
339 W RED BANK AVE, WEST DEPTFORD, NJ 08096-1417
(856) 236-5250
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
28RI03724000
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28RJ07080
IMMUNIZATION CERTIFICATION
NJ
Enumeration date
03/18/2017
Last updated
03/18/2017
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