Provider Demographics
NPI:1649438300
Name:POLIMENO, MARK WILLIAM (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WILLIAM
Last Name:POLIMENO
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 1:1201 N MARKET ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-1139
Mailing Address - Country:US
Mailing Address - Phone:302-660-3901
Mailing Address - Fax:302-660-3903
Practice Address - Street 1:1201 N MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1139
Practice Address - Country:US
Practice Address - Phone:302-660-3901
Practice Address - Fax:302-660-3903
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0003653183500000X
PARP448885183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist