MEDICARE: MR. DAVID G. MARTIN RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	0202005053	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0202005053	OTHER	VA	VA. PHARMACIST'S NUMBER

General Provider Information

NPI Number	:	1407945124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID G. MARTIN RPH

Provider Business Mailing Address
First Line	:	2616 SHERWOOD HALL LN STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-780-4612
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 SHERWOOD HALL LN STE 100
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22306-3154
Country	:	US
Telephone Number	:	703-780-4612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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