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General NPI Number Information
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NPI Number | 1104124098
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Entity Type | Individual
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Provider Name | LISA S. MARTIN RPH
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Gender | Female
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 3345 PINEVILLE MATTHEWS RD
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City | CHARLOTTE
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State | NC
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Zip | 28226-9304
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Country | US
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Telephone | 704-543-6055
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Fax |
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Provider Business Mailing Address
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Address Line | 906 JAYWOOD LN
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City | MATTHEWS
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State | NC
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Zip | 28105-5605
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Country | US
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Telephone | 704-847-4792
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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 | 09228
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License Number State | NC
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