Provider Demographics
NPI:1073905360
Name:MARCONE, POLLY
Entity Type:Individual
Prefix:
First Name:POLLY
Middle Name:
Last Name:MARCONE
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 1:18626 LE DAUPHINE PL
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2885
Mailing Address - Country:US
Mailing Address - Phone:813-527-1818
Mailing Address - Fax:
Practice Address - Street 1:18626 LE DAUPHINE PL
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-2885
Practice Address - Country:US
Practice Address - Phone:813-527-1818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41711183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist