Healthcare Provider Details

I. General information

NPI: 1457877243
Provider Name (Legal Business Name): KEVIN JOSEPH MERCER PHARMD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2017
Last Update Date: 12/11/2019
Certification Date: 12/11/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 W 23RD ST
PANAMA CITY FL
32405-4507
US

IV. Provider business mailing address

302 SHOAL POINT CT APT 202
PANAMA CITY BEACH FL
32407-0405
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-8341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number051.300878
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS59709
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25696
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019319
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: