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General NPI Number Information
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NPI Number | 1275616120
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Entity Type | Organization
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Legal Business Name | MARTY'S PHARMACY
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 9422 AVENUE L
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City | BROOKLYN
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State | NY
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Zip | 11236-4809
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Country | US
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Telephone | 718-251-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 9422 AVENUE L
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City | BROOKLYN
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State | NY
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Zip | 11236-4809
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER SUPERVISING PHARMACIST
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Name | MR. MARTIN NIEDELMAN
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Credential | RPH
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Telephone | 718-251-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 014605
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License Number State | NY
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