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General NPI Number Information
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NPI Number | 1649838194
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Entity Type | Individual
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Provider Name | MARC DANIEL IANNACCONE PHARMD
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Gender | Male
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Dates
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Enumeration Date | 05/30/2019
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 1100 SHERMAN AVE
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City | HAMDEN
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State | CT
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Zip | 06514-1363
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Country | US
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Telephone | 203-747-3933
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Fax |
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Provider Business Mailing Address
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Address Line | 221 PROSPECT ST # 2F
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City | ANSONIA
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State | CT
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Zip | 06401-1523
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Country | US
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Telephone | 203-606-8892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835X0200X
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Taxonomy Name | Oncology Pharmacist
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License Number | 0012100
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License Number State | CT
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