Provider Demographics
NPI:1003154253
Name:FUSCO, MARK J (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:FUSCO
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 1:377 TARRYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1423
Mailing Address - Country:US
Mailing Address - Phone:914-948-4141
Mailing Address - Fax:
Practice Address - Street 1:377 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1423
Practice Address - Country:US
Practice Address - Phone:914-948-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030790183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist