Individual
BRYAN EVAN MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.PH.
Contact information
Practice address
714 W 4TH ST, ADEL, GA 31620-2656
(229) 896-1601
(229) 896-1621
Mailing address
836 SHIFLETT RD, ADEL, GA 31620-7378
(229) 896-4772
(229) 896-1621
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH019619
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH019619
GA LICENSE
GA
Enumeration date
07/09/2011
Last updated
07/09/2011
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