Provider Demographics
NPI:1063044972
Name:MARTIN, FARRAH
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 BOSTON RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40514-1569
Mailing Address - Country:US
Mailing Address - Phone:859-223-4496
Mailing Address - Fax:859-223-3165
Practice Address - Street 1:3650 BOSTON RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40514-1569
Practice Address - Country:US
Practice Address - Phone:859-223-4496
Practice Address - Fax:859-223-3165
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2020-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0124241835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist