Provider Demographics
NPI:1427392190
Name:MARTIN PHARMACY LLC
Entity Type:Organization
Organization Name:MARTIN PHARMACY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHFAQ
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:R PH
Authorized Official - Phone:201-638-9538
Mailing Address - Street 1:1262 OLD TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-2122
Mailing Address - Country:US
Mailing Address - Phone:810-732-2893
Mailing Address - Fax:
Practice Address - Street 1:4130 CLIO RD STE B
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6011
Practice Address - Country:US
Practice Address - Phone:810-785-1000
Practice Address - Fax:810-785-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI333600000X
MI53010101413336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy