Provider Demographics
NPI:1215287370
Name:MARTIN, MARTHA WILLING (RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:WILLING
Last Name:MARTIN
Suffix:
Gender:F
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:P.O. BOX 1860
Mailing Address - Street 2:
Mailing Address - City:LANGLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29834
Mailing Address - Country:US
Mailing Address - Phone:803-593-3411
Mailing Address - Fax:
Practice Address - Street 1:2820 AUGUSTA RD
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:SC
Practice Address - Zip Code:29834
Practice Address - Country:US
Practice Address - Phone:803-593-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6390183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist