Organization
MARTIN MEMORIAL MEDICAL CENTER INC
Active
Other names
Martin Memorial Medical Center Outpatient Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY L. LONGVILLE (CHIEF ACCOUNTING OFFICER/CONTROLLER)
(216) 636-7416
Entity
Organization
Contact information
Practice address
200 SE HOSPITAL AVE, STUART, FL 34994-2346
(772) 288-5813
(772) 221-2064
Mailing address
200 HOSPITAL AVE, PO BOX 9010, STUART, FL 34995-2396
(772) 834-4980
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH9554
FL
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2009571
PK
—
Enumeration date
12/27/2006
Last updated
12/08/2022
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