Provider Demographics
NPI:1134716392
Name:MARTIN, JUDY CAROLE (RPH)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:CAROLE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:TX
Mailing Address - Zip Code:75835-2024
Mailing Address - Country:US
Mailing Address - Phone:936-544-2275
Mailing Address - Fax:936-206-7696
Practice Address - Street 1:107 S 4TH ST
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:TX
Practice Address - Zip Code:75835-2024
Practice Address - Country:US
Practice Address - Phone:936-544-2275
Practice Address - Fax:936-206-7696
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist