Provider Demographics
NPI:1437481629
Name:MARTINO, VICKIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:
Last Name:MARTINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2789 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4433
Mailing Address - Country:US
Mailing Address - Phone:718-266-2137
Mailing Address - Fax:718-266-2142
Practice Address - Street 1:2789 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4433
Practice Address - Country:US
Practice Address - Phone:718-266-2137
Practice Address - Fax:718-266-2142
Is Sole Proprietor?:No
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041797-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02389128Medicaid
NY02389128Medicaid