Provider Demographics
NPI:1538763974
Name:MARINO, VICKI LYNNE (RPH)
Entity type:Individual
Prefix:MRS
First Name:VICKI
Middle Name:LYNNE
Last Name:MARINO
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 1:22 KINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-3111
Mailing Address - Country:US
Mailing Address - Phone:862-703-0740
Mailing Address - Fax:
Practice Address - Street 1:29 DEFOREST AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-2155
Practice Address - Country:US
Practice Address - Phone:908-273-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02492100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist