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General NPI Number Information
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NPI Number | 1871107698
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Entity Type | Individual
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Provider Name | ROBERTA JO MARTIN PHARMD
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Gender | Female
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Dates
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Enumeration Date | 08/31/2020
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Last Update Date | 08/31/2020
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Provider Practice Location Address
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Address Line | 1311 N STATE ROUTE 48
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City | DECATUR
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State | IL
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Zip | 62526-3701
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Country | US
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Telephone | 217-429-1988
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Fax | 217-429-9577
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Provider Business Mailing Address
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Address Line | 425 N KICKAPOO ST
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City | LINCOLN
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State | IL
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Zip | 62656-2139
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Country | US
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Telephone | 217-871-4907
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Fax | 217-429-9577
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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 | 051.300115
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License Number State | IL
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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 | 051300115
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License Number State | IL
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