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General NPI Number Information
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NPI Number | 1285923508
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Entity Type | Individual
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Provider Name | MR. ROBERT WILLIAM MARTIN
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Gender | Male
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1106 S BUSINESS HIGHWAY 61
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City | BOWLING GREEN
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State | MO
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Zip | 63334-5233
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Country | US
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Telephone | 573-324-3383
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Fax | 573-324-6388
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Provider Business Mailing Address
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Address Line | 1106 S BUSINESS HIGHWAY 61
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City | BOWLING GREEN
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State | MO
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Zip | 63334-5233
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Country | US
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Telephone | 573-324-3383
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Fax | 573-324-6388
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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 | 041749
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License Number State | MO
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