Provider Demographics
NPI:1306631981
Name:HORTON, GWYNIVERE
Entity type:Individual
Prefix:MS
First Name:GWYNIVERE
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:VILLAS
Mailing Address - State:NJ
Mailing Address - Zip Code:08251-1837
Mailing Address - Country:US
Mailing Address - Phone:856-813-6414
Mailing Address - Fax:
Practice Address - Street 1:139 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:WEST CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-1237
Practice Address - Country:US
Practice Address - Phone:609-884-2368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RW05651000183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician