Individual
MARK R. MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.PH
Contact information
Practice address
510 S ELLIOTT ST, PRYOR, OK 74361-6411
(918) 825-2225
(918) 825-0972
Mailing address
1035 COVEY LN, LOCUST GROVE, OK 74352-7307
(918) 521-5756
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13412
OK
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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