Provider Demographics
NPI:1558498071
Name:MARTIN, GEORGE N (RPH, EMT-I)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:N
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH, EMT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 PITTMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-3602
Mailing Address - Country:US
Mailing Address - Phone:210-667-1001
Mailing Address - Fax:
Practice Address - Street 1:3190 PITTMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT HEDWIG
Practice Address - State:TX
Practice Address - Zip Code:78152-3602
Practice Address - Country:US
Practice Address - Phone:210-667-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31094146M00000X
TX17533183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate