MEDICARE: PAT MARTIN RPH INC

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	333600000X	Pharmacy	1706IR	LA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1919147	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1689763237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAT MARTIN RPH INC

Provider Business Mailing Address
First Line	:	1117 N MAIN ST
Second Line	:	STE A
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 N MAIN ST
Second Line	:	STE A
City	:	SAINT MARTINVILLE
State	:	LA
Zip	:	70582-3513
Country	:	US
Telephone Number	:	337-394-6058
Fax Number	:	337-394-3387

Authorized Official
Title or Position	:	OWNER
Name	:	MURPHY MARTIN
Credential	:
Telephone Number	:	337-394-6058

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/07/2023

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Directions to “PAT MARTIN RPH INC ” Practice Location

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