Provider Demographics
NPI:1225497852
Name:REGISTER, MARTIN WADE JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WADE
Last Name:REGISTER
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3527 CHARTER OAK WAY
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-9425
Mailing Address - Country:US
Mailing Address - Phone:865-363-6497
Mailing Address - Fax:
Practice Address - Street 1:3527 CHARTER OAK WAY
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-9425
Practice Address - Country:US
Practice Address - Phone:865-363-6497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist