Provider Demographics
NPI:1801025390
Name:CERCONE, TINA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:CERCONE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 UNION RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1215
Mailing Address - Country:US
Mailing Address - Phone:716-677-0735
Mailing Address - Fax:716-674-0970
Practice Address - Street 1:3008 UNION RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1215
Practice Address - Country:US
Practice Address - Phone:716-677-0735
Practice Address - Fax:716-674-0970
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053010183500000X
FLPS36181183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist