Healthcare Provider Details

I. General information

NPI: 1770838799
Provider Name (Legal Business Name): CORI ALLYN MARTINO PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COUNTY ROUTE 64
HORSEHEADS NY
14845-2297
US

IV. Provider business mailing address

7139 N DIVISION STREET RD
AUBURN NY
13021-8030
US

V. Phone/Fax

Practice location:
  • Phone: 607-739-2087
  • Fax:
Mailing address:
  • Phone: 315-406-1795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: