Provider Demographics
NPI:1598354318
Name:MARTIN, ELIZABETH C (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5124 OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1698
Mailing Address - Country:US
Mailing Address - Phone:941-349-1111
Mailing Address - Fax:941-312-0631
Practice Address - Street 1:5124 OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34242-1698
Practice Address - Country:US
Practice Address - Phone:941-349-1111
Practice Address - Fax:941-312-0631
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS198913336C0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy