Provider Demographics
NPI:1316206741
Name:MARTIN, SCOTT JASON (PHARMD)
Entity Type:Individual
Prefix:MISS
First Name:SCOTT
Middle Name:JASON
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 1:4412 SPRINGBRANCH DR
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7634
Mailing Address - Country:US
Mailing Address - Phone:832-687-2929
Mailing Address - Fax:
Practice Address - Street 1:4412 SPRINGBRANCH DR
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76116-7634
Practice Address - Country:US
Practice Address - Phone:832-687-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43317183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist