Provider Demographics
NPI:1992251565
Name:MARTIN, ROBERT III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:MARTIN
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WILKINS WISE RD
Mailing Address - Street 2:SUITE 38
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1725
Mailing Address - Country:US
Mailing Address - Phone:866-279-3314
Mailing Address - Fax:866-279-3315
Practice Address - Street 1:402 WILKINS WISE RD
Practice Address - Street 2:SUITE 38
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1725
Practice Address - Country:US
Practice Address - Phone:866-279-3314
Practice Address - Fax:866-279-3315
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-11812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist