Provider Demographics
NPI:1710217831
Name:MARTIN, THOMAS G (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:G
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 1:1517 N WILMOT RD # 151
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4410
Mailing Address - Country:US
Mailing Address - Phone:520-733-1846
Mailing Address - Fax:
Practice Address - Street 1:1517 N WILMOT RD # 151
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4410
Practice Address - Country:US
Practice Address - Phone:520-733-1846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS010715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist