Healthcare Provider Details

I. General information

NPI: 1346795291
Provider Name (Legal Business Name): JILLIAN RENEE MARTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 MCKNIGHT RD STE A
PITTSBURGH PA
15237-3416
US

IV. Provider business mailing address

109 CRYSTAL SPRINGS DR
CRANBERRY TOWNSHIP PA
16066-3929
US

V. Phone/Fax

Practice location:
  • Phone: 412-364-8100
  • Fax:
Mailing address:
  • Phone: 724-766-2758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP450929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: