Provider Demographics
NPI:1659748887
Name:MARTIN, ALISHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10601 US HIGHWAY 441
Mailing Address - Street 2:STE D
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7237
Mailing Address - Country:US
Mailing Address - Phone:352-365-6817
Mailing Address - Fax:352-360-0539
Practice Address - Street 1:10601 US HIGHWAY 441
Practice Address - Street 2:SUITE D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7237
Practice Address - Country:US
Practice Address - Phone:352-365-6817
Practice Address - Fax:352-360-0539
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist