Healthcare Provider Details

I. General information

NPI: 1134659998
Provider Name (Legal Business Name): KASEY ANN MARTIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MARKET STREET
ELIZABETH PA
15037
US

IV. Provider business mailing address

134 MOUNT VERNON DR
MCKEESPORT PA
15135-3000
US

V. Phone/Fax

Practice location:
  • Phone: 412-384-2890
  • Fax:
Mailing address:
  • Phone: 412-523-8887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP451420
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: