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General NPI Number Information
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NPI Number | 1962583542
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Entity Type | Individual
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Provider Name | MICHAEL LEE MARTIN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 711 N EDMONDS AVE
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City | MC CRORY
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State | AR
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Zip | 72101-8278
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Country | US
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Telephone | 870-731-2361
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Fax | 870-731-0075
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Provider Business Mailing Address
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Address Line | 201 SUMMERFIELD DR
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City | BRYANT
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State | AR
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Zip | 72022-3277
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Country | US
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Telephone | 501-653-2890
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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 | PD10359
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | PD10359
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License Number State | AR
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