Provider Demographics
NPI:1679858377
Name:MARTIN, GREGORY ASHLEY (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:ASHLEY
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-4815
Mailing Address - Country:US
Mailing Address - Phone:405-409-3931
Mailing Address - Fax:
Practice Address - Street 1:126 BROAD ST
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-4815
Practice Address - Country:US
Practice Address - Phone:478-783-4700
Practice Address - Fax:478-783-4706
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist