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General NPI Number Information
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NPI Number | 1306356092
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Entity Type | Organization
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Legal Business Name | MARTNICKS PHARMACY & MEDICAL SUPPLY INC
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Dates
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Enumeration Date | 10/06/2017
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 1107 E HALLANDALE BEACH BLVD STE B
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4431
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Country | US
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Telephone | 954-530-3024
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Fax | 954-530-4285
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Provider Business Mailing Address
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Address Line | 1107 E HALLANDALE BEACH BLVD STE B
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4431
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Country | US
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Telephone | 954-530-3024
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Fax | 954-530-4285
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | DR. ROBERT N ONYENWE
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Credential | RPHD
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Telephone | 954-530-4698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number | 25452
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License Number State | FL
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