MEDICARE: DR. KEN MARTIN PHARM.D.

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
1	1835N0905X	Nuclear Pharmacist	PH00021477	WA

General Provider Information

NPI Number	:	1457522948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN MARTIN PHARM.D.

Provider Business Mailing Address
First Line	:	4605 SW 328TH PL
Second Line	:
City	:	FEDERAL WAY
State	:	WA
Zip	:	98023-1925
Country	:	US
Telephone Number	:	425-275-3890
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 PACIFIC AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98418-7921
Country	:	US
Telephone Number	:	253-682-4660
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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