MEDICARE: MR. MARKO SHAKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39981	FL

General Provider Information

NPI Number	:	1205292216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARKO SHAKER

Provider Business Mailing Address
First Line	:	30606 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4414
Country	:	US
Telephone Number	:	727-773-9000
Fax Number	:	727-773-9001

Provider Business Practice Location Address
First Line	:	30606 US HIGHWAY 19 N
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4414
Country	:	US
Telephone Number	:	727-773-9000
Fax Number	:	727-773-9001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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Directions to “ MR. MARKO SHAKER ” Practice Location

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