Provider Demographics
NPI:1407132814
Name:MARTIN, CECELIA ANNE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CECELIA
Middle Name:ANNE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16803 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5510
Mailing Address - Country:US
Mailing Address - Phone:216-252-3102
Mailing Address - Fax:216-251-0549
Practice Address - Street 1:16803 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5510
Practice Address - Country:US
Practice Address - Phone:216-252-3102
Practice Address - Fax:216-251-0549
Is Sole Proprietor?:No
Enumeration Date:2011-10-30
Last Update Date:2011-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH030219551183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist