Provider Demographics
NPI:1760825558
Name:MARTIN, DEBORAH ANNMARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANNMARIE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N MCKINLEY ST
Mailing Address - Street 2:#111-620
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8099
Mailing Address - Country:US
Mailing Address - Phone:951-818-7054
Mailing Address - Fax:
Practice Address - Street 1:420 N MCKINLEY ST
Practice Address - Street 2:#111-620
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-8099
Practice Address - Country:US
Practice Address - Phone:951-898-8935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 52466183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist