MEDICARE: MR. MARK PHILIP TARQUINIO BS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP028207L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B943063	OTHER	PA	NABP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194812610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK PHILIP TARQUINIO BS PHARMACY

Provider Business Mailing Address
First Line	:	14 SOUTH MAIN ST
Second Line	:
City	:	MUNCY
State	:	PA
Zip	:	17756-1306
Country	:	US
Telephone Number	:	570-546-3270
Fax Number	:	570-546-2848

Provider Business Practice Location Address
First Line	:	14 SOUTH MAIN ST
Second Line	:	HARTERS DRUG STORE
City	:	MUNCY
State	:	PA
Zip	:	17756-1306
Country	:	US
Telephone Number	:	570-546-3270
Fax Number	:	570-546-2848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	07/08/2007

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