Provider Demographics
NPI:1598040909
Name:MARTIN, BRANDON ADRIEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ADRIEL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7029 ETZEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2458
Mailing Address - Country:US
Mailing Address - Phone:314-721-4370
Mailing Address - Fax:
Practice Address - Street 1:441 N KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-3911
Practice Address - Country:US
Practice Address - Phone:314-965-7944
Practice Address - Fax:314-909-7121
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1999141493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist