Provider Demographics
NPI:1457674194
Name:RAUCHWERGER, MARK STEVEN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:RAUCHWERGER
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 PONDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1359
Mailing Address - Country:US
Mailing Address - Phone:914-665-5555
Mailing Address - Fax:914-665-5562
Practice Address - Street 1:120 GRAMATAN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-1206
Practice Address - Country:US
Practice Address - Phone:914-665-5555
Practice Address - Fax:914-665-5562
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist