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NPI Code Detail

MEDICARE: MARY KATHERINE MARTIN

MEDICARE: MARY KATHERINE MARTIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist100249MS

General Provider Information

NPI Number : 1316610371
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY KATHERINE MARTIN
Provider Business Mailing Address
First Line : 1606 HIGHLAND COLONY PKWY
Second Line :
City : MADISON
State : MS
Zip : 39110-6917
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1606 HIGHLAND COLONY PKWY
Second Line :
City : MADISON
State : MS
Zip : 39110-6917
Country : US
Telephone Number : 601-605-5928
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2021
Last Update Date : 07/27/2021

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Directions to “ MARY KATHERINE MARTIN ” Practice Location

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