Provider Demographics
NPI:1952405433
Name:MARTIN, ROXANNA LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:LYNN
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 1:1420 QUAIL RD
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-7459
Mailing Address - Country:US
Mailing Address - Phone:785-632-6218
Mailing Address - Fax:
Practice Address - Street 1:708 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-1529
Practice Address - Country:US
Practice Address - Phone:785-632-3032
Practice Address - Fax:785-632-5943
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12111183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist