Provider Demographics
NPI:1427150176
Name:PORCELLI, MARK D (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:PORCELLI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 NW 88 AVENUE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351
Mailing Address - Country:US
Mailing Address - Phone:954-749-6965
Mailing Address - Fax:954-749-6138
Practice Address - Street 1:4201 NW 88 AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:954-749-6965
Practice Address - Fax:954-749-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21058183500000X
NY035822-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist