Provider Demographics
NPI:1124022512
Name:MARTINO, ANTHONY ANGELO (RPH)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ANGELO
Last Name:MARTINO
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 1:102 E BETHLEHEM BLVD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4866
Mailing Address - Country:US
Mailing Address - Phone:304-242-1500
Mailing Address - Fax:304-242-6889
Practice Address - Street 1:102 E BETHLEHEM BLVD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4866
Practice Address - Country:US
Practice Address - Phone:304-242-1500
Practice Address - Fax:304-242-6889
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0005745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist