Provider Demographics
NPI:1477812428
Name:MARKETTI, TONY PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:TONY
Middle Name:PAUL
Last Name:MARKETTI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:COAL CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60416-1481
Mailing Address - Country:US
Mailing Address - Phone:708-476-1189
Mailing Address - Fax:
Practice Address - Street 1:5001 SAN DARIO AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5777
Practice Address - Country:US
Practice Address - Phone:956-729-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51015183500000X
WI15725-40183500000X
IL051293964183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist