Provider Demographics
NPI:1346862695
Name:MARTIN, MEGAN SHEARRER
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:SHEARRER
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 1:1905 E STATE HIGHWAY 97
Mailing Address - Street 2:
Mailing Address - City:JOURDANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78026-1504
Mailing Address - Country:US
Mailing Address - Phone:830-769-5247
Mailing Address - Fax:
Practice Address - Street 1:1905 E STATE HIGHWAY 97
Practice Address - Street 2:
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1504
Practice Address - Country:US
Practice Address - Phone:830-769-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-09
Last Update Date:2020-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist