Provider Demographics
NPI:1598344996
Name:MARTIN, KELLI (PHARM D)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
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 1:1264 TAMU
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-1264
Mailing Address - Country:US
Mailing Address - Phone:979-458-8292
Mailing Address - Fax:
Practice Address - Street 1:1264 TAMU
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-1264
Practice Address - Country:US
Practice Address - Phone:979-458-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-05
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43209183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist