Provider Demographics
NPI:1972908556
Name:MARTIN, ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19315 MOUNTAIN MEADOW CT
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9579
Mailing Address - Country:US
Mailing Address - Phone:530-346-1408
Mailing Address - Fax:
Practice Address - Street 1:19315 MOUNTAIN MEADOW CT
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9579
Practice Address - Country:US
Practice Address - Phone:530-346-1408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-25
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH41348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist