Provider Demographics
NPI:1689859464
Name:MERCURIO, JOHN ANTHONY SR
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ANTHONY
Last Name:MERCURIO
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7398 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-3718
Mailing Address - Country:US
Mailing Address - Phone:315-451-3218
Mailing Address - Fax:315-451-4114
Practice Address - Street 1:7398 OSWEGO RD
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13090-3718
Practice Address - Country:US
Practice Address - Phone:315-451-3218
Practice Address - Fax:315-451-4114
Is Sole Proprietor?:No
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist