Provider Demographics
NPI:1528336922
Name:MARTIN, AIMEE C (RPH)
Entity type:Individual
Prefix:
First Name:AIMEE
Middle Name:C
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 1:1027 MARTIN ST
Mailing Address - Street 2:
Mailing Address - City:PARKS
Mailing Address - State:LA
Mailing Address - Zip Code:70582-6255
Mailing Address - Country:US
Mailing Address - Phone:337-845-5199
Mailing Address - Fax:337-845-5070
Practice Address - Street 1:1027 MARTIN ST
Practice Address - Street 2:
Practice Address - City:PARKS
Practice Address - State:LA
Practice Address - Zip Code:70582-6255
Practice Address - Country:US
Practice Address - Phone:337-845-5199
Practice Address - Fax:337-845-5070
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16609183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist