Provider Demographics
NPI:1376544122
Name:MARTIN, DAVID JOHN (PHARMD, FACN, CNS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOHN
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARMD, FACN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 NABORS DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5328
Mailing Address - Country:US
Mailing Address - Phone:256-442-4820
Mailing Address - Fax:256-442-4820
Practice Address - Street 1:2020 NABORS DR
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-5328
Practice Address - Country:US
Practice Address - Phone:256-442-4820
Practice Address - Fax:256-442-4820
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL143091835N1003X, 1835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy