Provider Demographics
NPI:1932457819
Name:MARTIN, DAVID LADON (RPH)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LADON
Last Name:MARTIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 IL 145 RD
Mailing Address - Street 2:
Mailing Address - City:METROPOLIS
Mailing Address - State:IL
Mailing Address - Zip Code:62960-4516
Mailing Address - Country:US
Mailing Address - Phone:618-524-3240
Mailing Address - Fax:
Practice Address - Street 1:203 E ADAIR ST
Practice Address - Street 2:
Practice Address - City:SMITHLAND
Practice Address - State:KY
Practice Address - Zip Code:42081-9164
Practice Address - Country:US
Practice Address - Phone:270-928-2161
Practice Address - Fax:270-928-2293
Is Sole Proprietor?:No
Enumeration Date:2012-08-26
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9561183500000X
IL051033440183500000X
KY015848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist