Provider Demographics
NPI:1003304379
Name:MARTELLA'S LTC MEDIPAC SERVICES LLC
Entity Type:Organization
Organization Name:MARTELLA'S LTC MEDIPAC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-535-1833
Mailing Address - Street 1:1079 FRANKLIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905
Mailing Address - Country:US
Mailing Address - Phone:814-535-5949
Mailing Address - Fax:814-539-2234
Practice Address - Street 1:1079 FRANKLIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905
Practice Address - Country:US
Practice Address - Phone:814-535-5949
Practice Address - Fax:814-539-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy