MEDICARE: DR. LINDA GORE 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	1835P1200X	Pharmacotherapy Pharmacist	1939	WY

General Provider Information

NPI Number	:	1942202296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA GORE MARTIN PHARM.D.

Provider Business Mailing Address
First Line	:	PO BOX 241
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82073-0241
Country	:	US
Telephone Number	:	307-742-4543
Fax Number	:	307-766-2953

Provider Business Practice Location Address
First Line	:	1000 E UNIVERSITY AVE
Second Line	:
City	:	LARAMIE
State	:	WY
Zip	:	82071-2000
Country	:	US
Telephone Number	:	307-766-6128
Fax Number	:	307-766-2953

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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