Provider Demographics
NPI:1306513742
Name:ABRAHAM, MARTHA E (BSPS, PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:E
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:BSPS, PHARMD, RPH
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:E
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2581 HIBISCUS WAY APT 208
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2389
Mailing Address - Country:US
Mailing Address - Phone:484-929-4550
Mailing Address - Fax:
Practice Address - Street 1:63 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:OH
Practice Address - Zip Code:45314-8637
Practice Address - Country:US
Practice Address - Phone:937-766-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist