Healthcare Provider Details

I. General information

NPI: 1477950384
Provider Name (Legal Business Name): MARTIN BLOOD BS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2014
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18947 JOHN J WILLIAMS HWY BEBE HEALTHCARE TUNNELL CANCER CENTER
REHOBOTH BEACH DE
19971-4474
US

IV. Provider business mailing address

424 SAVANNAH RD BEEBE HEALTHCARE MEDICAL CENTER
LEWES DE
19958-1462
US

V. Phone/Fax

Practice location:
  • Phone: 302-645-3100
  • Fax:
Mailing address:
  • Phone: 302-645-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number11232
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2546
License Number StateNH
# 3
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberA1-0004567
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: