Provider Demographics
NPI:1538280870
Name:JERRY W. MARTIN
Entity Type:Organization
Organization Name:JERRY W. MARTIN
Other - Org Name:RAPPAHANNOCK MEDICAL CENTER PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PERMITTED DEPENSING PHHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-675-3316
Mailing Address - Street 1:PO BOX 269
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22747-0269
Mailing Address - Country:US
Mailing Address - Phone:540-675-2950
Mailing Address - Fax:540-675-3692
Practice Address - Street 1:338 GAY STREET
Practice Address - Street 2:SUITE A
Practice Address - City:WASHINGTON
Practice Address - State:VA
Practice Address - Zip Code:22747-0269
Practice Address - Country:US
Practice Address - Phone:540-675-3316
Practice Address - Fax:540-675-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy