Provider Demographics
NPI:1275640021
Name:LOWE, MARTIN LANE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:LANE
Last Name:LOWE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21713 CARTERS LN
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-1074
Mailing Address - Country:US
Mailing Address - Phone:205-554-3737
Mailing Address - Fax:
Practice Address - Street 1:TUSCALOOSA VA MEDICAL CENTER
Practice Address - Street 2:3701 LOOP ROAD
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35404
Practice Address - Country:US
Practice Address - Phone:205-554-3737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist