Provider Demographics
NPI:1144503996
Name:KANE, MARIE (RPH)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 WEST ROUTE 130 S
Mailing Address - Street 2:WALGREENS
Mailing Address - City:BURLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4300
Mailing Address - Country:US
Mailing Address - Phone:609-747-9636
Mailing Address - Fax:609-747-7956
Practice Address - Street 1:2 WEST ROUTE 130 S
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08016
Practice Address - Country:US
Practice Address - Phone:609-747-9637
Practice Address - Fax:609-747-7956
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI24878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist