Provider Demographics
NPI:1285728931
Name:MARTIN PHARMACY SERVICES, LLC
Entity type:Organization
Organization Name:MARTIN PHARMACY SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-358-4840
Mailing Address - Street 1:2017 S GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3613
Mailing Address - Country:US
Mailing Address - Phone:417-358-4840
Mailing Address - Fax:417-358-8591
Practice Address - Street 1:2017 S GARRISON AVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3613
Practice Address - Country:US
Practice Address - Phone:417-358-4840
Practice Address - Fax:417-358-8591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2021015449OtherSTATE BOARD OF PHARMACY
MO600308803Medicaid
2051462OtherPK