Provider Demographics
NPI:1154870749
Name:MORIN, MARK (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MORIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 FIFTH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2965
Mailing Address - Country:US
Mailing Address - Phone:603-953-6617
Mailing Address - Fax:
Practice Address - Street 1:67 FIFTH ST APT 16
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2965
Practice Address - Country:US
Practice Address - Phone:603-953-6617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-24
Last Update Date:2016-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist