Individual
MATT MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1613 NORTH MAIN STREET, SAN LUIS, AZ 85349
(928) 722-7288
Mailing address
1613 N. MAIN STREET, SAN LUIS, AZ 85349
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
S013987
AZ
Other
Enumeration date
01/29/2014
Last updated
01/29/2014
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