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Organization
MARTIN AVENUE PHARMACY INC
Active
Organization
MARTIN AVENUE PHARMACY INC
Active
Other names
MARTIN AVENUE PHARMACY INC
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS MARKS RPH (PRESIDENT)
(630) 355-6400
Entity
Organization
Contact information
Practice address
1247 RICKERT DR, STE 100, NAPERVILLE, IL 60540-1008
(630) 355-6400
(630) 355-6522
Mailing address
1247 RICKERT DR, STE 100, NAPERVILLE, IL 60540-1008
(630) 355-6400
(630) 355-6522
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
054004976
IL
3336C0004X
Compounding Pharmacy
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2022622
PK
—
Enumeration date
07/03/2006
Last updated
07/11/2016
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