Provider Demographics
NPI:1316493513
Name:MARTIN, SAMUEL MACEO JR
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:MACEO
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAMUEL
Other - Middle Name:MACEO
Other - Last Name:MARTIN
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:326 EAST CAP. STREET NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-543-4400
Mailing Address - Fax:
Practice Address - Street 1:326 E CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3809
Practice Address - Country:US
Practice Address - Phone:202-543-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist