Healthcare Provider Details

I. General information

NPI: 1013126952
Provider Name (Legal Business Name): STEVEN J MARTIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 S MAIN ST UNIT 1
ADA OH
45810-1599
US

IV. Provider business mailing address

4850 DEER BROOK CT
SYLVANIA OH
43560-9240
US

V. Phone/Fax

Practice location:
  • Phone: 419-772-2277
  • Fax:
Mailing address:
  • Phone: 419-824-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number03-1-22684
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: