Healthcare Provider Details

I. General information

NPI: 1376544122
Provider Name (Legal Business Name): DAVID JOHN MARTIN PHARM.D., FACN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 NABORS DR
SOUTHSIDE AL
35907-5328
US

IV. Provider business mailing address

2020 NABORS DR
SOUTHSIDE AL
35907-5328
US

V. Phone/Fax

Practice location:
  • Phone: 256-442-4820
  • Fax: 256-442-4820
Mailing address:
  • Phone: 256-442-4820
  • Fax: 256-442-4820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License Number14309
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number14309
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number14309
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: