Provider Demographics
NPI:1679192223
Name:MARTIN-YEBOAH, GARRETTE (PHARMD, MPH)
Entity Type:Individual
Prefix:
First Name:GARRETTE
Middle Name:
Last Name:MARTIN-YEBOAH
Suffix:
Gender:F
Credentials:PHARMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10404 RIDGLAND RD
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2701
Mailing Address - Country:US
Mailing Address - Phone:443-622-4735
Mailing Address - Fax:
Practice Address - Street 1:10404 RIDGLAND RD
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2701
Practice Address - Country:US
Practice Address - Phone:443-622-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12345OtherN/A