Healthcare Provider Details

I. General information

NPI: 1265837330
Provider Name (Legal Business Name): CARLY JO MARTIN PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 ROSS CLARK CIR STE 100
DOTHAN AL
36303
US

IV. Provider business mailing address

110 HEALTHEAST DR
DOTHAN AL
36303-1282
US

V. Phone/Fax

Practice location:
  • Phone: 334-792-4281
  • Fax:
Mailing address:
  • Phone: 334-794-4211
  • Fax: 334-712-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20476
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: