Provider Demographics
NPI:1407141922
Name:BOYD, MARTIN A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:A
Last Name:BOYD
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 1:155 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4474
Mailing Address - Country:US
Mailing Address - Phone:574-243-9042
Mailing Address - Fax:574-243-9042
Practice Address - Street 1:155 E UNIVERSITY DR
Practice Address - Street 2:1445
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-4474
Practice Address - Country:US
Practice Address - Phone:574-243-9042
Practice Address - Fax:574-243-9042
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26023725A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist