Provider Demographics
NPI:1134659998
Name:MARTIK, KASEY ANN
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ANN
Last Name:MARTIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 MOUNT VERNON DR
Mailing Address - Street 2:
Mailing Address - City:MCKEESPORT
Mailing Address - State:PA
Mailing Address - Zip Code:15135-3000
Mailing Address - Country:US
Mailing Address - Phone:412-523-8887
Mailing Address - Fax:
Practice Address - Street 1:300 MARKET STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037
Practice Address - Country:US
Practice Address - Phone:412-384-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP451420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist