=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700995875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARTELLA'S PHARMACY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 05/26/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1079 FRANKLIN ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15905-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-535-1833
-----------------------------------------------------
Fax | 814-539-2234
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1079 FRANKLIN ST
-----------------------------------------------------
City | JOHNSTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15905-4303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 814-535-1833
-----------------------------------------------------
Fax | 814-539-2234
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | JACQUELINE MARTELLA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 814-535-1833
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------