Provider Demographics
NPI:1164802005
Name:MARTIN, KATHRYN FARLEY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:FARLEY
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 1:2275 EDMONSON DR
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1402
Mailing Address - Country:US
Mailing Address - Phone:214-287-1346
Mailing Address - Fax:
Practice Address - Street 1:3313 ESSEX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082
Practice Address - Country:US
Practice Address - Phone:214-765-5456
Practice Address - Fax:214-765-5477
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist