Provider Demographics
NPI:1649838194
Name:IANNACCONE, MARC DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DANIEL
Last Name:IANNACCONE
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 1:221 PROSPECT ST # 2F
Mailing Address - Street 2:
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1523
Mailing Address - Country:US
Mailing Address - Phone:203-606-8892
Mailing Address - Fax:
Practice Address - Street 1:1100 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-1363
Practice Address - Country:US
Practice Address - Phone:203-747-3933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00121001835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology