Mark J Quackenbush, PHARMD RPH
Individual provider Active NPI Pharmacist · Freehold, NY
NPI 1295069359 · NPPES record last updated Sep 22, 2009
Key facts
- NPI
- 1295069359
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 032698 (NY)
- Practice address
- 420 Big Woods Rd
Freehold, NY 12431-5107 - Phone
- (518) 634-7406
- NPI assigned
- Sep 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy, Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 032698 | NY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 032698 | NY | Yes |
Addresses
Primary practice location
420 Big Woods Rd
Freehold, NY 12431-5107
Mailing address
420 Big Woods Rd
Freehold, NY 12431-5107
Phone (518) 634-7406
Other providers in Freehold, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.