Provider Demographics
NPI:1700995875
Name:MARTELLA'S PHARMACY, LLC
Entity type:Organization
Organization Name:MARTELLA'S PHARMACY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-535-1833
Mailing Address - Street 1:1079 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-4303
Mailing Address - Country:US
Mailing Address - Phone:814-535-1833
Mailing Address - Fax:814-539-2234
Practice Address - Street 1:1079 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-4303
Practice Address - Country:US
Practice Address - Phone:814-535-1833
Practice Address - Fax:814-539-2234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA3336C0003X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4755400001Medicare NSC