Provider Demographics
NPI:1306390570
Name:MARTIN, SARAHANN LAUZON
Entity Type:Individual
Prefix:
First Name:SARAHANN
Middle Name:LAUZON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 WILGROVE MINT HILL RD
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3400
Mailing Address - Country:US
Mailing Address - Phone:704-545-3420
Mailing Address - Fax:704-573-4227
Practice Address - Street 1:4307 WILGROVE MINT HILL RD
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-3400
Practice Address - Country:US
Practice Address - Phone:704-545-3420
Practice Address - Fax:704-573-4227
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26299183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0606780Medicaid