Provider Demographics
NPI:1912999392
Name:MARTIN, DORINDA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DORINDA
Middle Name:L
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 1:410 GOLF CREST LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4636
Mailing Address - Country:US
Mailing Address - Phone:512-261-8603
Mailing Address - Fax:512-608-0311
Practice Address - Street 1:100 COMMONS RD STE 1
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3966
Practice Address - Country:US
Practice Address - Phone:512-858-7935
Practice Address - Fax:512-858-1630
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist