Provider Demographics
NPI:1609169754
Name:MARTIN, DAVID CALVIN (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CALVIN
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 1:4739 SAINT STEPHENS RD
Mailing Address - Street 2:
Mailing Address - City:PRICHARD
Mailing Address - State:AL
Mailing Address - Zip Code:36613-3512
Mailing Address - Country:US
Mailing Address - Phone:251-457-6666
Mailing Address - Fax:251-457-6667
Practice Address - Street 1:4739 SAINT STEPHENS RD
Practice Address - Street 2:
Practice Address - City:PRICHARD
Practice Address - State:AL
Practice Address - Zip Code:36613-3512
Practice Address - Country:US
Practice Address - Phone:251-457-6666
Practice Address - Fax:251-457-6667
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7365183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist