Provider Demographics
NPI:1194812610
Name:TARQUINIO, MARK PHILIP (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:PHILIP
Last Name:TARQUINIO
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SOUTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCY
Mailing Address - State:PA
Mailing Address - Zip Code:17756-1306
Mailing Address - Country:US
Mailing Address - Phone:570-546-3270
Mailing Address - Fax:570-546-2848
Practice Address - Street 1:14 SOUTH MAIN ST
Practice Address - Street 2:HARTERS DRUG STORE
Practice Address - City:MUNCY
Practice Address - State:PA
Practice Address - Zip Code:17756-1306
Practice Address - Country:US
Practice Address - Phone:570-546-3270
Practice Address - Fax:570-546-2848
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP028207L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB943063OtherNABP
PA1009867220001Medicaid
PA1009867220001Medicaid