Provider Demographics
NPI:1073980199
Name:MARTIN, MEGAN (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 S MOUNT CARMEL PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6604
Mailing Address - Country:US
Mailing Address - Phone:620-240-8035
Mailing Address - Fax:620-240-8034
Practice Address - Street 1:1011 S MOUNT CARMEL PL
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6604
Practice Address - Country:US
Practice Address - Phone:620-240-8035
Practice Address - Fax:620-240-8034
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-16803183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist