Provider Demographics
NPI:1568693802
Name:MERCURIO, THOMAS C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:MERCURIO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LOCUST ST
Mailing Address - Street 2:#6G - NORTH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-3914
Mailing Address - Country:US
Mailing Address - Phone:845-661-2458
Mailing Address - Fax:
Practice Address - Street 1:1601 CHERRY ST
Practice Address - Street 2:3 PARKWAY - SUITE 1700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1321
Practice Address - Country:US
Practice Address - Phone:187-788-2782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP443387183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist