Provider Demographics
NPI:1831411800
Name:MERCOGLIANO, VINCENT R (RPH)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:R
Last Name:MERCOGLIANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 PATRICK LN
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2936
Mailing Address - Country:US
Mailing Address - Phone:845-485-3784
Mailing Address - Fax:888-502-5642
Practice Address - Street 1:84 PATRICK LN
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2936
Practice Address - Country:US
Practice Address - Phone:845-485-3784
Practice Address - Fax:888-502-5642
Is Sole Proprietor?:No
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0480111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist