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NPI Code Detail

MEDICARE: DR. J KELLY MARTIN JR. PHARM.D.

MEDICARE: DR. J KELLY MARTIN JR. 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
11835P1200XPharmacotherapy PharmacistPH00009377WA

General Provider Information

NPI Number : 1972593721
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. J KELLY MARTIN JR. PHARM.D.
Provider Business Mailing Address
First Line : 6775 WEATHER GLASS LN
Second Line :
City : GIG HARBOR
State : WA
Zip : 98335-5106
Country : US
Telephone Number : 253-426-6692
Fax Number : 253-426-4949
Provider Business Practice Location Address
First Line : 1717 S J ST
Second Line : PHARMACY DEPT
City : TACOMA
State : WA
Zip : 98405-4933
Country : US
Telephone Number : 253-426-6692
Fax Number : 253-426-4949
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2005
Last Update Date : 07/08/2007

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