Provider Demographics
NPI:1578932125
Name:MARTELLO, JENNY (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:MARTELLO
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 SYCAMORE POINT TRL
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8306
Mailing Address - Country:US
Mailing Address - Phone:336-886-1889
Mailing Address - Fax:
Practice Address - Street 1:160 LOWES BLVD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-5347
Practice Address - Country:US
Practice Address - Phone:336-249-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18694183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist