Provider Demographics
NPI:1205292216
Name:SHAKER, MARKO
Entity type:Individual
Prefix:MR
First Name:MARKO
Middle Name:
Last Name:SHAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30606 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-4414
Mailing Address - Country:US
Mailing Address - Phone:727-773-9000
Mailing Address - Fax:727-773-9001
Practice Address - Street 1:30606 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4414
Practice Address - Country:US
Practice Address - Phone:727-773-9000
Practice Address - Fax:727-773-9001
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist