Individual
KENNETH MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1811 WEST GOVT ST, BRANDON, MS 39042-2106
(601) 828-3773
Mailing address
100 GREENBROOK DR, BRANDON, MS 39042-2106
(601) 540-2121
Taxonomy
Speciality
Code
Description
License number
State
1835P0018X
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Primary
E-7098
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
E-7098
MS BOARD OF PHARMACY
MS
Enumeration date
02/20/2020
Last updated
02/20/2020
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