Healthcare Provider Details

I. General information

NPI: 1124022512
Provider Name (Legal Business Name): ANTHONY ANGELO MARTINO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E BETHLEHEM BLVD
WHEELING WV
26003-4866
US

IV. Provider business mailing address

102 E BETHLEHEM BLVD
WHEELING WV
26003-4866
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-1500
  • Fax: 304-242-6889
Mailing address:
  • Phone: 304-242-1500
  • Fax: 304-242-6889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0005745
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: