Provider Demographics
NPI:1821682097
Name:MARTIN, CHRISTOPHER RONALD (CPHT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:RONALD
Last Name:MARTIN
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:RONALD
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT
Mailing Address - Street 1:PO BOX 3162
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24143-3162
Mailing Address - Country:US
Mailing Address - Phone:540-505-7546
Mailing Address - Fax:
Practice Address - Street 1:7373 PEPPERS FERRY BLVD
Practice Address - Street 2:
Practice Address - City:FAIRLAWN
Practice Address - State:VA
Practice Address - Zip Code:24141-8857
Practice Address - Country:US
Practice Address - Phone:540-731-4033
Practice Address - Fax:540-731-4038
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0230018858183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician