Provider Demographics
NPI:1073948238
Name:MARTIN, CRAIG ANTHONY (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 S GUILD AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3170
Mailing Address - Country:US
Mailing Address - Phone:800-468-4334
Mailing Address - Fax:800-828-8787
Practice Address - Street 1:850 S GUILD AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3170
Practice Address - Country:US
Practice Address - Phone:800-468-4334
Practice Address - Fax:800-828-8787
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist