Provider Demographics
NPI:1891128302
Name:MARTIN, BARRY WILLIAM (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:WILLIAM
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-7395
Mailing Address - Country:US
Mailing Address - Phone:803-648-1776
Mailing Address - Fax:
Practice Address - Street 1:110 PRICE AVE
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-7395
Practice Address - Country:US
Practice Address - Phone:803-648-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9072183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist