Provider Demographics
NPI:1386306272
Name:KERINS, DAVID MICHAEL RAQUIZA
Entity type:Individual
Prefix:
First Name:DAVID MICHAEL
Middle Name:RAQUIZA
Last Name:KERINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 HOSPITALITY WAY
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1646
Mailing Address - Country:US
Mailing Address - Phone:732-299-8431
Mailing Address - Fax:
Practice Address - Street 1:680 BOUND BROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-2109
Practice Address - Country:US
Practice Address - Phone:908-821-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04210000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist