Provider Demographics
NPI:1740428945
Name:MARTELLA, JACQUELINE M (RPH)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:M
Last Name:MARTELLA
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:P.O. BOX 266
Mailing Address - Street 2:131 SCHOOLHOUSE ROAD
Mailing Address - City:JENNERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15547
Mailing Address - Country:US
Mailing Address - Phone:814-629-1397
Mailing Address - Fax:814-629-9179
Practice Address - Street 1:131 SCHOOLHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:JENNERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15547
Practice Address - Country:US
Practice Address - Phone:814-629-1397
Practice Address - Fax:814-629-9179
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP035400L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist