Provider Demographics
NPI:1780198473
Name:MISURACA, MARC (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:MISURACA
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 1:9934 67TH RD APT 4K
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3063
Mailing Address - Country:US
Mailing Address - Phone:516-507-8263
Mailing Address - Fax:
Practice Address - Street 1:3007 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1200
Practice Address - Country:US
Practice Address - Phone:516-507-8263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist