Provider Demographics
NPI:1003191156
Name:MARKAKIS, RITA KATHLEEN (RPH)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:KATHLEEN
Last Name:MARKAKIS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 BROADWAY AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2660
Mailing Address - Country:US
Mailing Address - Phone:330-372-4105
Mailing Address - Fax:330-372-3913
Practice Address - Street 1:2154 ELM RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-4005
Practice Address - Country:US
Practice Address - Phone:330-372-4105
Practice Address - Fax:330-372-3913
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03215221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03215221OtherOHIO STATE BOARD OF PHARMACY IDENTIFICATION NUMBER