Healthcare Provider Details

I. General information

NPI: 1881292431
Provider Name (Legal Business Name): RANDY MARTINS HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9947 KINGSTON PIKE
KNOXVILLE TN
37922-6923
US

IV. Provider business mailing address

9947 KINGSTON PIKE
KNOXVILLE TN
37922-6923
US

V. Phone/Fax

Practice location:
  • Phone: 865-909-9713
  • Fax:
Mailing address:
  • Phone: 865-909-9713
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DAVID RANDALL MARTIN
Title or Position: OWNER
Credential: PHARMD
Phone: 865-909-9713