Healthcare Provider Details

I. General information

NPI: 1215221593
Provider Name (Legal Business Name): MARTNICKS PHARMACY & DISCOUNT SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2011
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 E HALLANDALE BEACH BLVD STE A
HALLANDALE BEACH FL
33009-4431
US

IV. Provider business mailing address

1107 E HALLANDALE BEACH BLVD STE A
HALLANDALE BEACH FL
33009-4431
US

V. Phone/Fax

Practice location:
  • Phone: 954-530-4698
  • Fax: 954-530-4922
Mailing address:
  • Phone: 954-530-4698
  • Fax: 954-530-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPH25453
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ONYENWE
Title or Position: PRESIDENT
Credential:
Phone: 954-530-4698