Provider Demographics
NPI:1568587855
Name:MARTIN, ROWENA GAIL (PT)
Entity Type:Individual
Prefix:MS
First Name:ROWENA
Middle Name:GAIL
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 NEW HOPE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FOXWORTH
Mailing Address - State:MS
Mailing Address - Zip Code:39483-4872
Mailing Address - Country:US
Mailing Address - Phone:601-736-4755
Mailing Address - Fax:
Practice Address - Street 1:771 U.S. HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MS
Practice Address - Zip Code:39429
Practice Address - Country:US
Practice Address - Phone:601-736-7799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS02602183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician