Provider Demographics
NPI:1689763237
Name:PAT MARTIN RPH INC
Entity Type:Organization
Organization Name:PAT MARTIN RPH INC
Other - Org Name:MEDICINE SHOPPE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MURPHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-394-6058
Mailing Address - Street 1:1117 N MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:SAINT MARTINVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70582-3513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1117 N MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:SAINT MARTINVILLE
Practice Address - State:LA
Practice Address - Zip Code:70582-3513
Practice Address - Country:US
Practice Address - Phone:337-394-6058
Practice Address - Fax:337-394-3387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1706IR333600000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1253766Medicaid
1919147OtherOTHER ID NUMBER-COMMERCIAL NUMBER
LAAP1737969OtherDEA #
LA5128840001Medicare NSC