Provider Demographics
NPI:1902182595
Name:MARTIN, CYNTHIA M (RPH)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7061 RADIUS LOOP SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98513-5134
Mailing Address - Country:US
Mailing Address - Phone:616-901-4002
Mailing Address - Fax:
Practice Address - Street 1:4280 MARTIN WAY E
Practice Address - Street 2:SAFEWAY #27-1952
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5354
Practice Address - Country:US
Practice Address - Phone:360-456-0709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH 60233154183500000X
HIPH 2826183500000X
MI5302031874183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist