Provider Demographics
NPI:1871500348
Name:MARTIN, CLARENCE J (MARTINS PHARMACY RPH)
Entity Type:Individual
Prefix:MR
First Name:CLARENCE
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:MARTINS PHARMACY RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076
Mailing Address - Country:US
Mailing Address - Phone:859-441-5181
Mailing Address - Fax:859-441-5549
Practice Address - Street 1:3800 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:COLD SPRING
Practice Address - State:KY
Practice Address - Zip Code:41076
Practice Address - Country:US
Practice Address - Phone:859-441-5181
Practice Address - Fax:859-441-5549
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005943183500000X
KYP00283183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0635360001Medicare ID - Type Unspecified