Provider Demographics
NPI:1649558529
Name:MARTIN, JILLIAN MARIE (RPH)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:MARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248-1623
Mailing Address - Country:US
Mailing Address - Phone:513-574-5044
Mailing Address - Fax:513-574-3457
Practice Address - Street 1:5830 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-1623
Practice Address - Country:US
Practice Address - Phone:513-574-5044
Practice Address - Fax:513-574-3457
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-255661835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-3-25566OtherSTATE BOARD OF PHARMACY