MEDICARE: MARTELLA'S PHARMACY OF LIGONIER, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1740754696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTELLA'S PHARMACY OF LIGONIER, LLC

Provider Business Mailing Address
First Line	:	113 S FAIRFIELD ST STE 1
Second Line	:
City	:	LIGONIER
State	:	PA
Zip	:	15658-1163
Country	:	US
Telephone Number	:	724-238-6988
Fax Number	:	724-238-7781

Provider Business Practice Location Address
First Line	:	113 S FAIRFIELD ST STE 1
Second Line	:
City	:	LIGONIER
State	:	PA
Zip	:	15658-1163
Country	:	US
Telephone Number	:	724-238-6988
Fax Number	:	724-238-7781

Authorized Official
Title or Position	:	OWNER
Name	:	JACQUELINE M. MARTELLA
Credential	:	R.PH.
Telephone Number	:	814-629-1397

Provider Enumeration Date	:	01/14/2019
Last Update Date	:	04/30/2024

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