Provider Demographics
NPI:1770095648
Name:MARTINEK, ALEXA KYLE
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:KYLE
Last Name:MARTINEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ALEXA
Other - Middle Name:KYLE
Other - Last Name:POOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 W 9TH ST APT 630
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-1035
Mailing Address - Country:US
Mailing Address - Phone:330-651-4125
Mailing Address - Fax:
Practice Address - Street 1:10701 EAST BLVD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1702
Practice Address - Country:US
Practice Address - Phone:216-791-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03237268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist