Healthcare Provider Details

I. General information

NPI: 1699790659
Provider Name (Legal Business Name): JUSTIN TODD MARTIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 NE STUCKI AVE
HILLSBORO OR
97124-5806
US

IV. Provider business mailing address

2875 NE STUCKI AVE
HILLSBORO OR
97124-5806
US

V. Phone/Fax

Practice location:
  • Phone: 971-310-4050
  • Fax:
Mailing address:
  • Phone: 971-310-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number0009636
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number9636
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: