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General NPI Number Information
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NPI Number | 1063004026
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Entity Type | Individual
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Provider Name | BRIAN JOHN MARTIN RPH
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Gender | Male
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 10666 BUSINESS 21
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City | HILLSBORO
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State | MO
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Zip | 63050-5097
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Country | US
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Telephone | 636-797-3468
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Fax |
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Provider Business Mailing Address
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Address Line | 400 FLUCOM MDWS
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City | DE SOTO
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State | MO
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Zip | 63020-3517
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Country | US
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Telephone | 314-276-2242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044440
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License Number State | MO
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