Provider Demographics
NPI:1508998980
Name:MARTIN, SUSAN JILL (RPH)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:JILL
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 1:5668 BURNETT DR S
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:OH
Mailing Address - Zip Code:43021-9229
Mailing Address - Country:US
Mailing Address - Phone:740-548-0987
Mailing Address - Fax:
Practice Address - Street 1:200 HOFF RD UNIT B
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7154
Practice Address - Country:US
Practice Address - Phone:614-212-8423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-22138183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist