Provider Demographics
NPI:1558544882
Name:BERARDINO, MARC C (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:C
Last Name:BERARDINO
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 1:5045 JENKINS RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3915
Mailing Address - Country:US
Mailing Address - Phone:315-829-3696
Mailing Address - Fax:315-339-6499
Practice Address - Street 1:RITE AID PHARMACY
Practice Address - Street 2:1727 BLACK RIVER BLVD
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-336-8890
Practice Address - Fax:315-339-6499
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031492183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist