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General NPI Number Information
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NPI Number | 1669817904
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Entity Type | Individual
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Provider Name | EMORY SPENCER MARTIN III PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2013
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Last Update Date | 04/30/2013
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Provider Practice Location Address
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Address Line | 2401 S 31ST ST SWMH PHARMACY MS-01-055
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City | TEMPLE
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State | TX
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Zip | 76508-0001
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Country | US
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Telephone | 254-724-3811
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Fax | 254-725-5017
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Provider Business Mailing Address
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Address Line | 2401 S 31ST ST SWMH PHARMACY MS-01-055
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City | TEMPLE
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State | TX
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Zip | 76508-0001
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Country | US
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Telephone | 254-724-3811
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Fax | 254-725-5017
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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 | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 30166
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License Number State | TX
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