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General NPI Number Information
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NPI Number | 1285235978
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Entity Type | Individual
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Provider Name | DESIRAE MERCURI
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Gender | Female
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Dates
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Enumeration Date | 11/08/2020
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Last Update Date | 11/08/2020
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Provider Practice Location Address
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Address Line | 314 W ARMY TRAIL RD
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2300
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Country | US
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Telephone | 630-893-5382
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Fax |
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Provider Business Mailing Address
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Address Line | 7829 W CARMEN AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-3207
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 051.296252
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License Number State | IL
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