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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054004976
IL
3336C0004X
Compounding Pharmacy
—
—
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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