Provider Demographics
NPI:1053655662
Name:MARTIN, RYAN GILBERT (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:GILBERT
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-1887
Mailing Address - Country:US
Mailing Address - Phone:254-953-5881
Mailing Address - Fax:
Practice Address - Street 1:201 E CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-1887
Practice Address - Country:US
Practice Address - Phone:254-953-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52411183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist