Provider Demographics
NPI:1679896294
Name:MERCARDANTE, KRISTINE JOAN
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JOAN
Last Name:MERCARDANTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 CARMAN AVENUE
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-997-8330
Mailing Address - Fax:516-997-1994
Practice Address - Street 1:822 CARMAN AVE
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6428
Practice Address - Country:US
Practice Address - Phone:516-997-8330
Practice Address - Fax:516-997-1994
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0391481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist