Healthcare Provider Details

I. General information

NPI: 1962583542
Provider Name (Legal Business Name): MICHAEL LEE MARTIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N EDMONDS AVE
MC CRORY AR
72101-8278
US

IV. Provider business mailing address

201 SUMMERFIELD DR
BRYANT AR
72022-3277
US

V. Phone/Fax

Practice location:
  • Phone: 870-731-2361
  • Fax: 870-731-0075
Mailing address:
  • Phone: 501-653-2890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPD10359
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPD10359
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: