Provider Demographics
NPI:1013057652
Name:MARTIN PHARMACY INVESTMENTS PLLC
Entity Type:Organization
Organization Name:MARTIN PHARMACY INVESTMENTS PLLC
Other - Org Name:KINSEY'S PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-561-5656
Mailing Address - Street 1:4290 KINSEY DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1024
Mailing Address - Country:US
Mailing Address - Phone:903-561-5656
Mailing Address - Fax:903-534-5468
Practice Address - Street 1:4290 KINSEY DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1024
Practice Address - Country:US
Practice Address - Phone:903-561-5656
Practice Address - Fax:903-534-5468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX298903336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2152603OtherPK
TX4009550001Medicare NSC