Provider Demographics
NPI:1306867122
Name:MARTELLAS PHARMACY OF PARKHILL LLC
Entity Type:Organization
Organization Name:MARTELLAS PHARMACY OF PARKHILL LLC
Other - Org Name:MARTELLA'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-754-5717
Mailing Address - Street 1:1932 WILLIAM PENN AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909-1637
Mailing Address - Country:US
Mailing Address - Phone:814-322-1011
Mailing Address - Fax:814-322-3334
Practice Address - Street 1:1932 WILLIAM PENN AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15909-1637
Practice Address - Country:US
Practice Address - Phone:814-322-1011
Practice Address - Fax:814-322-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP411767L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2133280OtherPK
PA6751510001Medicare NSC