MEDICARE: DR. PHILLIP MARTEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	206034034	MO

General Provider Information

NPI Number	:	1629768544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP MARTEL

Provider Business Mailing Address
First Line	:	1720 S 9TH ST APT 1B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3994
Country	:	US
Telephone Number	:	913-593-3513
Fax Number	:

Provider Business Practice Location Address
First Line	:	1720 S 9TH ST APT 1B
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63104-3994
Country	:	US
Telephone Number	:	913-593-3513
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2023
Last Update Date	:	05/12/2023

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Directions to “ DR. PHILLIP MARTEL ” Practice Location

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