MEDICARE: DR. NICHOLAS JAMES 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	183500000X	Pharmacist	2006024033	MO

General Provider Information

NPI Number	:	1649497587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS JAMES MARTIN PHARM. D.

Provider Business Mailing Address
First Line	:	2501 CONIFEROUS DR
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62221-7960
Country	:	US
Telephone Number	:	314-435-7344
Fax Number	:

Provider Business Practice Location Address
First Line	:	3865 GRAVOIS AVE
Second Line	:	PHARMACY
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-4657
Country	:	US
Telephone Number	:	314-771-0218
Fax Number	:

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

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/08/2007

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