Provider Demographics
NPI:1669683587
Name:MARTIN, DAN E (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:E
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13534 NW 7TH RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-4457
Mailing Address - Country:US
Mailing Address - Phone:352-474-6048
Mailing Address - Fax:
Practice Address - Street 1:90 SW 250TH ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-472-2253
Practice Address - Fax:352-472-5515
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 15005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist