Organization
MARTIN MEMORIAL PHYSICIAN CORPORATION, INC
Active
Other names
MHPG Tradition Pharmacy at Martin Health
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
10080 SW INNOVATION WAY STE 102, PORT ST LUCIE, FL 34987-2129
(772) 345-8166
(772) 345-8167
Mailing address
10080 SW INNOVATION WAY STE 102, PORT ST LUCIE, FL 34987-2129
(772) 345-8166
(772) 345-8167
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PH30943
FL
Other
Enumeration date
09/21/2017
Last updated
12/08/2022
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