Provider Demographics
NPI:1013246446
Name:MERCADO, MARK R (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:MERCADO
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 1:710 NORTH BELL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-250-0867
Mailing Address - Fax:512-250-5350
Practice Address - Street 1:710 N BELL BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2214
Practice Address - Country:US
Practice Address - Phone:512-250-0867
Practice Address - Fax:512-250-5350
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist