Martin Avenue Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054004976 Issued in IL

Legal business name

MARTIN AVENUE PHARMACY INC

Practice address

1247 Rickert Dr
Ste 100
Naperville, IL 60540-1008

Phone

(630) 355-6400

Fax

(630) 355-6522

NPI assigned

Jul 3, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thomas Marks, RPH

Title

President

Phone

(630) 355-6400

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• MARTIN AVENUE PHARMACY INC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lori Lee Gilmour, R. PH.

  • Pharmacist
  • Naperville, IL
  • NPI 1093087199
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468195200000",
    "number": "1609806983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1247 RICKERT DR",
            "address_2": "STE 100",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401008",
            "telephone_number": "630-355-6400",
            "fax_number": "630-355-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1247 RICKERT DR",
            "address_2": "STE 100",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605401008",
            "telephone_number": "630-355-6400",
            "fax_number": "630-355-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN AVENUE PHARMACY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2016-07-11",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-355-6400",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054004976",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2022622",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARTIN AVENUE PHARMACY INC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Marsala, DDS
• Desiree Marsden, BCBA
• Marshall Safeharbor Veteran & Senior Community Care
• Astrid Marshall, MD
• Martin Avenue Chiropractic & Wellness S.C
• Alexandra Danielle Martin
• Angela Martin, LCPC
• Janice Martin
• Jill Mary Martin, RPH
• John Martin, PH.D.

• All providers in Naperville, IL
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.