Provider Demographics
NPI:1750392254
Name:MARTINS MARK-IT PHARMACY INC
Entity type:Organization
Organization Name:MARTINS MARK-IT PHARMACY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-642-3200
Mailing Address - Street 1:5201 CAPITOL BLVD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-4418
Mailing Address - Country:US
Mailing Address - Phone:360-943-4043
Mailing Address - Fax:360-943-4810
Practice Address - Street 1:5201 CAPITOL BLVD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-4418
Practice Address - Country:US
Practice Address - Phone:360-943-4043
Practice Address - Fax:360-943-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WA602645643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2135667OtherPK
4920206OtherNCPDP PROVIDER IDENTIFICATION NUMBER