Provider Demographics
NPI:1457947095
Name:MARTIN, DEBORAH E (RPH)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:E
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 1:1600 BOSTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01129-1466
Mailing Address - Country:US
Mailing Address - Phone:413-543-5428
Mailing Address - Fax:413-543-4200
Practice Address - Street 1:1600 BOSTON RD STE 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01129-1466
Practice Address - Country:US
Practice Address - Phone:413-543-5428
Practice Address - Fax:413-543-4200
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH18528183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist