MEDICARE: ANTONELLA MARTINO PHARM.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS39764	FL
2	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PU5920	FL

General Provider Information

NPI Number	:	1073885125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONELLA MARTINO PHARM.D.

Provider Business Mailing Address
First Line	:	8720 WOODGROVE HARBOR LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4840
Country	:	US
Telephone Number	:	954-650-2147
Fax Number	:

Provider Business Practice Location Address
First Line	:	8720 WOODGROVE HARBOR LN
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33473-4840
Country	:	US
Telephone Number	:	954-650-2147
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2012
Last Update Date	:	02/06/2012

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