Healthcare Provider Details

I. General information

NPI: 1346367257
Provider Name (Legal Business Name): KERRI MARTIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W APACHE TRL CVS/PHARMACY
APACHE JUNCTION AZ
85120-3954
US

IV. Provider business mailing address

8615 E CRESCENT AVE
MESA AZ
85208-2297
US

V. Phone/Fax

Practice location:
  • Phone: 480-983-1129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2006035339
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number14858
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: