Healthcare Provider Details

I. General information

NPI: 1982996310
Provider Name (Legal Business Name): SHARON MARTELLA RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11211 S DIXIE HWY
PINECREST FL
33156-4441
US

IV. Provider business mailing address

6400 SW 145TH ST
CORAL GABLES FL
33158-1836
US

V. Phone/Fax

Practice location:
  • Phone: 786-242-3456
  • Fax:
Mailing address:
  • Phone: 305-256-4534
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS25903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: