Provider Demographics
NPI:1780117184
Name:MARTINELLI, CHARLES W (RPH)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:W
Last Name:MARTINELLI
Suffix:
Gender:M
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:PO BOX 150
Mailing Address - Street 2:121 DOLL RD
Mailing Address - City:REEDERS
Mailing Address - State:PA
Mailing Address - Zip Code:18352-0150
Mailing Address - Country:US
Mailing Address - Phone:570-460-7926
Mailing Address - Fax:570-420-2425
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-476-3455
Practice Address - Fax:570-420-2425
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP027167L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist