Provider Demographics
NPI:1124151568
Name:TOSCANO, MARK LOUIS (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LOUIS
Last Name:TOSCANO
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 1:2544 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9605
Mailing Address - Country:US
Mailing Address - Phone:315-638-4440
Mailing Address - Fax:
Practice Address - Street 1:115 ONEIDA ST
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-1227
Practice Address - Country:US
Practice Address - Phone:315-593-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036828-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist