Provider Demographics
NPI:1104109529
Name:MERCALDO, PETER JOSEPH (RPH)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOSEPH
Last Name:MERCALDO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1946
Mailing Address - Country:US
Mailing Address - Phone:516-627-2500
Mailing Address - Fax:
Practice Address - Street 1:588 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1946
Practice Address - Country:US
Practice Address - Phone:516-627-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY41702183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist