Provider Demographics
NPI:1902403546
Name:MARTIN, STUART LOBDELL (PHARM D)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:LOBDELL
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 N GOLIAD ST
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-7049
Mailing Address - Country:US
Mailing Address - Phone:972-961-9335
Mailing Address - Fax:
Practice Address - Street 1:3070 N GOLIAD ST
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-7049
Practice Address - Country:US
Practice Address - Phone:972-961-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67732183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist