Provider Demographics
NPI:1881208262
Name:SIU, MERCEDE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MERCEDE
Middle Name:
Last Name:SIU
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 1:84 SANDHURST CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-3100
Mailing Address - Country:US
Mailing Address - Phone:716-393-1567
Mailing Address - Fax:
Practice Address - Street 1:1827 MAIN ST
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2505
Practice Address - Country:US
Practice Address - Phone:914-737-3728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61486183500000X
NY066858183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist