Provider Demographics
NPI:1861818445
Name:MARTIN, ANDREA MAXINE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:MAXINE
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 1:907 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-3402
Mailing Address - Country:US
Mailing Address - Phone:269-683-0234
Mailing Address - Fax:
Practice Address - Street 1:907 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-3402
Practice Address - Country:US
Practice Address - Phone:269-683-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-06
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302034431183500000X
FLPS34098183500000X
IN26020956A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist