Provider Demographics
NPI:1982809067
Name:MARTIN, ERICA ELIZABETH (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:ELIZABETH
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:ELIZABETH
Other - Last Name:DANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10010 E 123RD ST S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-3481
Mailing Address - Country:US
Mailing Address - Phone:918-970-6062
Mailing Address - Fax:
Practice Address - Street 1:744 W 9TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9020
Practice Address - Country:US
Practice Address - Phone:918-408-4404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK13850183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist