Provider Demographics
NPI:1467013870
Name:MARTIN, JAMES JEFFREY (RPH)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JEFFREY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-2024
Mailing Address - Country:US
Mailing Address - Phone:936-544-2275
Mailing Address - Fax:
Practice Address - Street 1:107 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-2024
Practice Address - Country:US
Practice Address - Phone:936-544-2275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist