Provider Demographics
NPI:1316312002
Name:MARTIN, ABIGAIL (RPH)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
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 1:7470 CHERRY AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-4272
Mailing Address - Country:US
Mailing Address - Phone:909-281-3600
Mailing Address - Fax:909-281-3610
Practice Address - Street 1:7470 CHERRY AVE STE 111
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4272
Practice Address - Country:US
Practice Address - Phone:909-281-3600
Practice Address - Fax:909-281-3610
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650361835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417349978Medicaid