Provider Demographics
NPI:1083745525
Name:MARTIN, RAYMOND JOSEPH (RPH)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 TALLMADGE PL
Mailing Address - Street 2:
Mailing Address - City:MECHANICVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118-2320
Mailing Address - Country:US
Mailing Address - Phone:518-664-0731
Mailing Address - Fax:
Practice Address - Street 1:53 TALLMADGE PL
Practice Address - Street 2:
Practice Address - City:MECHANICVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118-2320
Practice Address - Country:US
Practice Address - Phone:518-664-0731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2167183500000X, 1835G0303X, 1835N0905X, 1835N1003X, 1835P1200X, 1835P1300X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Not Answered1835N0905XPharmacy Service ProvidersPharmacistNuclear
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
Not Answered1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
Not Answered1835P1300XPharmacy Service ProvidersPharmacistPsychiatric
Not Answered1835X0200XPharmacy Service ProvidersPharmacistOncology