MEDICARE: MR. MARK ALLAN PLACEK RPH

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	8802	OR
2	183500000X	Pharmacist	9750	NE

General Provider Information

NPI Number	:	1457684573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ALLAN PLACEK RPH

Provider Business Mailing Address
First Line	:	4380 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-399-8148
Fax Number	:

Provider Business Practice Location Address
First Line	:	4380 COMMERCIAL ST SE
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-3914
Country	:	US
Telephone Number	:	503-399-8148
Fax Number	:

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

Provider Enumeration Date	:	09/08/2009
Last Update Date	:	09/08/2009

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