Provider Demographics
NPI:1124618699
Name:MARTZIN, VERNON GEORGE (RPH)
Entity type:Individual
Prefix:
First Name:VERNON
Middle Name:GEORGE
Last Name:MARTZIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HUGH COX RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4141
Mailing Address - Country:US
Mailing Address - Phone:423-747-1000
Mailing Address - Fax:
Practice Address - Street 1:300 MED TECH PKWY
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2277
Practice Address - Country:US
Practice Address - Phone:423-302-1086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9228183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist