Provider Demographics
NPI:1811195209
Name:AGBARA, POLYCARP I (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:POLYCARP
Middle Name:I
Last Name:AGBARA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3020 S COMBEE RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-7306
Mailing Address - Country:US
Mailing Address - Phone:863-668-8490
Mailing Address - Fax:863-668-8497
Practice Address - Street 1:3020 S COMBEE RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803
Practice Address - Country:US
Practice Address - Phone:863-668-8490
Practice Address - Fax:863-668-8497
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist