Provider Demographics
NPI:1407023153
Name:HERMENET, MARK R (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:HERMENET
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 1:7017 BEAR SWAMP RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:NY
Mailing Address - Zip Code:14589-9787
Mailing Address - Country:US
Mailing Address - Phone:315-589-9370
Mailing Address - Fax:315-589-9370
Practice Address - Street 1:4061 ROUTE 104
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:NY
Practice Address - Zip Code:14589-9554
Practice Address - Country:US
Practice Address - Phone:315-589-4691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist