Provider Demographics
NPI:1740754696
Name:MARTELLA'S PHARMACY OF LIGONIER, LLC
Entity Type:Organization
Organization Name:MARTELLA'S PHARMACY OF LIGONIER, LLC
Other - Org Name:LIGONIER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:814-629-1397
Mailing Address - Street 1:113 S FAIRFIELD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:LIGONIER
Mailing Address - State:PA
Mailing Address - Zip Code:15658-1163
Mailing Address - Country:US
Mailing Address - Phone:724-238-6988
Mailing Address - Fax:724-238-7781
Practice Address - Street 1:113 S FAIRFIELD ST STE 1
Practice Address - Street 2:
Practice Address - City:LIGONIER
Practice Address - State:PA
Practice Address - Zip Code:15658-1163
Practice Address - Country:US
Practice Address - Phone:724-238-6988
Practice Address - Fax:724-238-7781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-14
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies