Individual
MS. JACQUELYN KEENAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
1477 W MAIN ST, SALEM, VA 24153-3120
(540) 389-7251
(540) 387-1876
Mailing address
PO BOX 11780, BLACKSBURG, VA 24062-1780
(704) 661-7051
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
006153
SC
183500000X
Pharmacist
Primary
0202206150
VA
183500000X
Pharmacist
10804
NC
Other
Enumeration date
08/29/2011
Last updated
08/29/2011
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