Provider Demographics
NPI:1689968877
Name:REID, MARTIN ROBERT (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ROBERT
Last Name:REID
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 1:1020 E BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:NEEDLES
Mailing Address - State:CA
Mailing Address - Zip Code:92363-3809
Mailing Address - Country:US
Mailing Address - Phone:760-326-2944
Mailing Address - Fax:760-326-6290
Practice Address - Street 1:1020 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:NEEDLES
Practice Address - State:CA
Practice Address - Zip Code:92363-3809
Practice Address - Country:US
Practice Address - Phone:760-326-2944
Practice Address - Fax:760-326-6290
Is Sole Proprietor?:No
Enumeration Date:2011-06-05
Last Update Date:2011-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32328183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist