Provider Demographics
NPI:1306285713
Name:MARTINCIC, TOMMY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:
Last Name:MARTINCIC
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 1:2531 WOODRUFF ROAD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681
Mailing Address - Country:US
Mailing Address - Phone:864-520-1550
Mailing Address - Fax:864-520-1550
Practice Address - Street 1:2531 WOODRUFF RD
Practice Address - Street 2:SUITE 107
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-5465
Practice Address - Country:US
Practice Address - Phone:864-520-1550
Practice Address - Fax:864-520-1550
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14664183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist