Provider Demographics
NPI:1982208872
Name:MYERS, MARTIN L III
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:L
Last Name:MYERS
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 FARRIER LN
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-2177
Mailing Address - Country:US
Mailing Address - Phone:615-794-8483
Mailing Address - Fax:
Practice Address - Street 1:101 FARRIER LN
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-2177
Practice Address - Country:US
Practice Address - Phone:615-794-8483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3802183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist