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General NPI Number Information
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NPI Number | 1063403970
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Entity Type | Individual
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Provider Name | BRENDA RAE MARTIN RPH
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | OSAWATOMIE STATE HOSPITAL RT 1 BOX 500
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City | OSAWATOMIE
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State | KS
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Zip | 66064
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Country | US
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Telephone | 913-755-7213
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Fax | 913-755-7045
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Provider Business Mailing Address
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Address Line | 309 E PEORIA ST
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City | PAOLA
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State | KS
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Zip | 66071-1710
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Country | US
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Telephone | 913-557-3562
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Fax | 913-755-7045
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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 | 1835P1300X
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Taxonomy Name | Psychiatric Pharmacist
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License Number | 11686
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License Number State | KS
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