Provider Demographics
NPI:1215221593
Name:MARTNICKS PHARMACY & DISCOUNT SERVICES INC.
Entity Type:Organization
Organization Name:MARTNICKS PHARMACY & DISCOUNT SERVICES INC.
Other - Org Name:MARTNICKS PHARMACY & DISCOUNT SCVS, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ONYENWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-530-4698
Mailing Address - Street 1:1107 E HALLANDALE BEACH BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4431
Mailing Address - Country:US
Mailing Address - Phone:954-530-4698
Mailing Address - Fax:954-530-4922
Practice Address - Street 1:1107 E HALLANDALE BEACH BLVD STE A
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4431
Practice Address - Country:US
Practice Address - Phone:954-530-4698
Practice Address - Fax:954-530-4922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-04
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 3336L0003X
FLPH254533336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004851500Medicaid
2130670OtherPK
2130670OtherPK