Provider Demographics
NPI:1629528708
Name:MARTIN, MEGAN (PHARM D)
Entity Type:Individual
Prefix:
First Name:MEGAN
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 1:18525 YORBA LINDA BLVD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4135
Mailing Address - Country:US
Mailing Address - Phone:714-777-2737
Mailing Address - Fax:717-777-9252
Practice Address - Street 1:18525 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886
Practice Address - Country:US
Practice Address - Phone:714-777-2737
Practice Address - Fax:714-777-9252
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-12
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist