Provider Demographics
NPI:1972327336
Name:MARTIN, KIRA ALISA (PHARMD)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:ALISA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 KNIGHTDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-9268
Mailing Address - Country:US
Mailing Address - Phone:919-266-7600
Mailing Address - Fax:
Practice Address - Street 1:7201 KNIGHTDALE BLVD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-9268
Practice Address - Country:US
Practice Address - Phone:919-266-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist