Provider Demographics
NPI:1346795291
Name:MARTIN, JILLIAN RENEE
Entity Type:Individual
Prefix:
First Name:JILLIAN
Middle Name:RENEE
Last Name:MARTIN
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 1:109 CRYSTAL SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-3929
Mailing Address - Country:US
Mailing Address - Phone:724-766-2758
Mailing Address - Fax:
Practice Address - Street 1:4770 MCKNIGHT RD
Practice Address - Street 2:STE A
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3416
Practice Address - Country:US
Practice Address - Phone:412-364-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP450929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist