MEDICARE: B & L MARTIN INVESTMENTS LLC

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	3336C0003X	Community/Retail Pharmacy	PHRE009489	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1157610	OTHER		NCPDP PROVIDER IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1649427493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	B & L MARTIN INVESTMENTS LLC

Provider Business Mailing Address
First Line	:	836 SHIFLETT RD
Second Line	:
City	:	ADEL
State	:	GA
Zip	:	31620-7378
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 N HUTCHINSON AVE
Second Line	:
City	:	ADEL
State	:	GA
Zip	:	31620-2344
Country	:	US
Telephone Number	:	229-896-4444
Fax Number	:	229-896-4494

Authorized Official
Title or Position	:	CO OWNER
Name	:	BRYAN MARTIN
Credential	:
Telephone Number	:	229-896-4444

Provider Enumeration Date	:	08/24/2008
Last Update Date	:	08/24/2008

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Directions to “B & L MARTIN INVESTMENTS LLC ” Practice Location

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