Provider Demographics
NPI:1073650487
Name:MARTIN, TONYA MARIE (RPH)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 RIDGEVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-8924
Mailing Address - Country:US
Mailing Address - Phone:606-438-3182
Mailing Address - Fax:
Practice Address - Street 1:93 ISOM PLAZA BOX 250
Practice Address - Street 2:
Practice Address - City:ISOM
Practice Address - State:KY
Practice Address - Zip Code:41824
Practice Address - Country:US
Practice Address - Phone:606-633-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist