Provider Demographics
NPI:1518555838
Name:NATIVIDAD, MARVIN EARL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:EARL
Last Name:NATIVIDAD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 PATTON DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-2313
Mailing Address - Country:US
Mailing Address - Phone:732-690-5470
Mailing Address - Fax:
Practice Address - Street 1:380 ROUTE 18
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2114
Practice Address - Country:US
Practice Address - Phone:732-651-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04132200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist