Provider Demographics
NPI:1508112400
Name:MARTIN, JOHN RYAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RYAN
Last Name:MARTIN
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 1:4519 TRENTON LOOP SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4800
Mailing Address - Country:US
Mailing Address - Phone:406-559-6007
Mailing Address - Fax:
Practice Address - Street 1:3520 PACIFIC AVE SE
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2121
Practice Address - Country:US
Practice Address - Phone:360-491-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWAPH60021633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist