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General NPI Number Information
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NPI Number | 1265837330
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Entity Type | Individual
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Provider Name | CARLY JO MARTIN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 10/30/2014
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 3525 ROSS CLARK CIR STE 100
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City | DOTHAN
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State | AL
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Zip | 36303
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Country | US
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Telephone | 334-792-4281
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Fax |
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Provider Business Mailing Address
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Address Line | 110 HEALTHEAST DR
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City | DOTHAN
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State | AL
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Zip | 36303-1282
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Country | US
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Telephone | 334-794-4211
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Fax | 334-712-6791
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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 | 20476
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License Number State | AL
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