Healthcare Provider Details

I. General information

NPI: 1669817904
Provider Name (Legal Business Name): EMORY SPENCER MARTIN III PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EMORY SPENCER MOORE PHARMD

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST SWMH PHARMACY MS-01-055
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

2401 S 31ST ST SWMH PHARMACY MS-01-055
TEMPLE TX
76508-0001
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-3811
  • Fax: 254-725-5017
Mailing address:
  • Phone: 254-724-3811
  • Fax: 254-725-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number30166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: