Provider Demographics
NPI:1699952481
Name:MERCURIO, MARC JOHN (RPH)
Entity type:Individual
Prefix:MR
First Name:MARC
Middle Name:JOHN
Last Name:MERCURIO
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 1:45 HOMESTEAD RD
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5806
Mailing Address - Country:US
Mailing Address - Phone:518-695-4199
Mailing Address - Fax:
Practice Address - Street 1:1169 ROUTE 29
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834
Practice Address - Country:US
Practice Address - Phone:518-692-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist