Provider Demographics
NPI:1477613321
Name:MERCURIO, DIANA G (RPH)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:G
Last Name:MERCURIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STONY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-2131
Mailing Address - Country:US
Mailing Address - Phone:401-437-8097
Mailing Address - Fax:401-456-3781
Practice Address - Street 1:25 STONY BROOK DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-2131
Practice Address - Country:US
Practice Address - Phone:401-437-8097
Practice Address - Fax:401-456-3781
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist