Provider Demographics
NPI:1093889917
Name:MARTIN, KARA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:A
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 1:203 BLUEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1120
Mailing Address - Country:US
Mailing Address - Phone:570-504-7381
Mailing Address - Fax:
Practice Address - Street 1:609 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-1813
Practice Address - Country:US
Practice Address - Phone:570-961-1168
Practice Address - Fax:570-207-4633
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP437689183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARP437689OtherSTATE LICENSE NUMBER