Healthcare Provider Details

I. General information

NPI: 1073897856
Provider Name (Legal Business Name): MICHAEL DAVID MARTIN JR. PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MIRANOVA PL STE 500
COLUMBUS OH
43215-7052
US

IV. Provider business mailing address

2966 ALUM TRAIL PL
LEWIS CENTER OH
43035-8353
US

V. Phone/Fax

Practice location:
  • Phone: 614-362-0209
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03325719
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: