Provider Demographics
NPI:1124252762
Name:MERCURI, DENISE M
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:MERCURI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S BLAKELY ST
Mailing Address - Street 2:
Mailing Address - City:DUNMORE
Mailing Address - State:PA
Mailing Address - Zip Code:18512-2203
Mailing Address - Country:US
Mailing Address - Phone:570-343-5525
Mailing Address - Fax:570-347-6882
Practice Address - Street 1:217 S BLAKELY ST
Practice Address - Street 2:
Practice Address - City:DUNMORE
Practice Address - State:PA
Practice Address - Zip Code:18512-2203
Practice Address - Country:US
Practice Address - Phone:570-343-5525
Practice Address - Fax:570-347-6882
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP031264L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist