Mark Scott Gravenstine
Individual provider Active NPI Pharmacist · Ocean City, NJ
NPI 1639769813 · NPPES record last updated Jan 21, 2021
Key facts
- NPI
- 1639769813
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 28RI01770000 (NJ)
- Practice address
- 1128 Bay Ave Apt 14
Ocean City, NJ 08226-3300 - Phone
- (609) 220-3726
- NPI assigned
- Jan 21, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28RI01770000 | NJ | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 28RI01770000 | NJ | Yes |
Addresses
Primary practice location
1128 Bay Ave Apt 14
Ocean City, NJ 08226-3300
Mailing address
1128 Bay Ave Apt 14
Ocean City, NJ 08226-3300
Phone (609) 220-3726
Other providers in Ocean City, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2021. 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.