Provider Demographics
NPI:1346891918
Name:MARTIN'S PHARMACY OF RURAL RETREAT INC
Entity Type:Organization
Organization Name:MARTIN'S PHARMACY OF RURAL RETREAT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HAMPTON
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:540-230-4250
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301-0699
Mailing Address - Country:US
Mailing Address - Phone:540-230-4250
Mailing Address - Fax:540-980-3784
Practice Address - Street 1:100 W BUCK AVE
Practice Address - Street 2:
Practice Address - City:RURAL RETREAT
Practice Address - State:VA
Practice Address - Zip Code:24368-2515
Practice Address - Country:US
Practice Address - Phone:276-250-2160
Practice Address - Fax:276-250-2184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-25
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy