Provider Demographics
NPI:1639211857
Name:MARTIN, AMY LYNNETTE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:LYNNETTE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:LYNNETTE
Other - Last Name:CUNNINGHAM MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:204 N AVENUE L
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-4841
Mailing Address - Country:US
Mailing Address - Phone:940-864-5927
Mailing Address - Fax:940-864-3731
Practice Address - Street 1:100 S AVENUE E
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5711
Practice Address - Country:US
Practice Address - Phone:940-864-2673
Practice Address - Fax:940-864-3731
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40923183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist