Provider Demographics
NPI:1639301385
Name:MARTIN, LEVI JEH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LEVI
Middle Name:JEH
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 S HIGHWAY 97 STE 150
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0320
Mailing Address - Country:US
Mailing Address - Phone:206-413-9475
Mailing Address - Fax:866-922-4730
Practice Address - Street 1:2127 S HIGHWAY 97 STE 150
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-0320
Practice Address - Country:US
Practice Address - Phone:206-413-9475
Practice Address - Fax:866-922-4730
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0011784183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist