Provider Demographics
NPI:1598276370
Name:POHLY, DAVIS MARIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVIS
Middle Name:MARIO
Last Name:POHLY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 N MARINE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5120
Mailing Address - Country:US
Mailing Address - Phone:773-769-1315
Mailing Address - Fax:
Practice Address - Street 1:4720 N MARINE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5120
Practice Address - Country:US
Practice Address - Phone:773-769-1315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051300630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist