Provider Demographics
NPI:1851675557
Name:CABLK, MARTIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:CABLK
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 1:501 SUNNYVALE DR
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3013
Mailing Address - Country:US
Mailing Address - Phone:707-431-1937
Mailing Address - Fax:
Practice Address - Street 1:501 SUNNYVALE DR
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3013
Practice Address - Country:US
Practice Address - Phone:707-431-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28259183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist