Provider Demographics
NPI:1679692529
Name:MARTIN, JOHN F (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:F
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 1:2476 BUSBY RD
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-8658
Mailing Address - Country:US
Mailing Address - Phone:360-679-2401
Mailing Address - Fax:
Practice Address - Street 1:31645 STATE ROUTE 20
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-3173
Practice Address - Country:US
Practice Address - Phone:360-679-3522
Practice Address - Fax:360-679-2948
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00011388183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist