Provider Demographics
NPI:1275121501
Name:MARTIN, ROCKY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROCKY
Middle Name:
Last Name:MARTIN
Suffix:
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 1:901 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2928
Mailing Address - Country:US
Mailing Address - Phone:501-206-0146
Mailing Address - Fax:501-206-0215
Practice Address - Street 1:901 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2928
Practice Address - Country:US
Practice Address - Phone:501-206-0146
Practice Address - Fax:501-206-0215
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist