Healthcare Provider Details

I. General information

NPI: 1588584940
Provider Name (Legal Business Name): ANDREW MARTIN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 POLO PKWY
MIDLOTHIAN VA
23113-4822
US

IV. Provider business mailing address

3120 POLO PKWY
MIDLOTHIAN VA
23113-4822
US

V. Phone/Fax

Practice location:
  • Phone: 804-594-3791
  • Fax:
Mailing address:
  • Phone: 804-594-3791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number02022223741
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: