Provider Demographics
NPI:1013503796
Name:PORCARO, MARK MICHAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MICHAEL
Last Name:PORCARO
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 1:23 DODGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1517
Mailing Address - Country:US
Mailing Address - Phone:617-962-6635
Mailing Address - Fax:
Practice Address - Street 1:23 DODGE RD
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-1517
Practice Address - Country:US
Practice Address - Phone:617-962-6635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH26557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist