Provider Demographics
NPI:1629164934
Name:POLLI, MARK LEO (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEO
Last Name:POLLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-7902
Mailing Address - Country:US
Mailing Address - Phone:207-885-2806
Mailing Address - Fax:207-885-3121
Practice Address - Street 1:145 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9309
Practice Address - Country:US
Practice Address - Phone:207-885-2086
Practice Address - Fax:207-885-3121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist