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General NPI Number Information
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NPI Number | 1487425252
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Entity Type | Individual
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Provider Name | KELLY MARTIN PHARM.D.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 01/11/2024
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Provider Practice Location Address
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Address Line | 196 SHAWNEE MALL DR
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City | SHAWNEE
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State | OK
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Zip | 74804-1337
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Country | US
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Telephone | 405-878-0281
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Fax |
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Provider Business Mailing Address
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Address Line | 201 HARBIN AVE
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City | WAXAHACHIE
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State | TX
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Zip | 75165-2441
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Country | US
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Telephone | 214-682-5193
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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 | 37757
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 11696
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License Number State | OK
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