Provider Demographics
NPI:1598900326
Name:MARTIN, BLAIR DAVID (RPH)
Entity Type:Individual
Prefix:MR
First Name:BLAIR
Middle Name:DAVID
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 LORIMER DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-4018
Mailing Address - Country:US
Mailing Address - Phone:216-849-5259
Mailing Address - Fax:216-447-8610
Practice Address - Street 1:2006 LORIMER DR
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-4018
Practice Address - Country:US
Practice Address - Phone:216-849-5259
Practice Address - Fax:216-447-8610
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219549183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist