MEDICARE: MS. JACQUELINE M. MARTELLA RPH

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	RP035400L	PA

General Provider Information

NPI Number	:	1740428945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JACQUELINE M. MARTELLA RPH

Provider Business Mailing Address
First Line	:	P.O. BOX 266
Second Line	:	131 SCHOOLHOUSE ROAD
City	:	JENNERSTOWN
State	:	PA
Zip	:	15547
Country	:	US
Telephone Number	:	814-629-1397
Fax Number	:	814-629-9179

Provider Business Practice Location Address
First Line	:	131 SCHOOLHOUSE ROAD
Second Line	:
City	:	JENNERSTOWN
State	:	PA
Zip	:	15547
Country	:	US
Telephone Number	:	814-629-1397
Fax Number	:	814-629-9179

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

Provider Enumeration Date	:	01/26/2009
Last Update Date	:	04/30/2024

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