Provider Demographics
NPI:1790011500
Name:PRIDE, MARTHA SIBERT (RPH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:SIBERT
Last Name:PRIDE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18756 WICOMICO RIVER DR.
Mailing Address - Street 2:P.O. BOX 349
Mailing Address - City:COBB ISLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20625-0349
Mailing Address - Country:US
Mailing Address - Phone:301-259-4187
Mailing Address - Fax:
Practice Address - Street 1:18756 WICOMICO RIVER DR.
Practice Address - Street 2:B. 349
Practice Address - City:COBB ISLAND
Practice Address - State:MD
Practice Address - Zip Code:20625-0349
Practice Address - Country:US
Practice Address - Phone:301-259-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD100001835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10000OtherSTATE BOARD OF PHARMACY