MEDICARE: MARK MARTELL

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	043974	NY

General Provider Information

NPI Number	:	1215259643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MARTELL

Provider Business Mailing Address
First Line	:	94 SOMERSET RD
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 SOMERSET RD
Second Line	:
City	:	HOPEWELL JUNCTION
State	:	NY
Zip	:	12533-3233
Country	:	US
Telephone Number	:	845-896-4055
Fax Number	:

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

Provider Enumeration Date	:	02/26/2010
Last Update Date	:	02/26/2010

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