Active NPI
Shedrick Martin, PHARMD, BCPP
- Pharmacist
- San Rafael, CA
National Provider Identifier
1457823155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 77539
- Practice address
- 111 Smith Ranch Rd
San Rafael, CA 94903-1939 - Phone
- (415) 491-3000
- NPI assigned
- Dec 19, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacotherapy Pharmacist | 1835P1200X | 77539 | CA | |
| Pharmacotherapy Pharmacist | 1835P1200X | 7539 | CA | |
| Psychiatric Pharmacist | 1835P1300X | 77539 | CA | |
| Ambulatory Care Pharmacist | 1835P2201X | 77539 | CA | |
| Pharmacist | 183500000X | 77539 | CA | Primary |
Addresses
Primary practice location
111 Smith Ranch Rd
San Rafael, CA 94903-1939
Mailing address
111 Smith Ranch Rd
San Rafael, CA 94903-1939
Phone (415) 491-3000
Other practice location 1
3900 Lakeville Hwy
Petaluma, CA 94954-5698
Phone (707) 765-3900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7539 | CA | MD | Counselor |
| 77539 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666569600000",
"number": "1457823155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "111 SMITH RANCH RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031939",
"telephone_number": "415-491-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 SMITH RANCH RD",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949031939",
"telephone_number": "415-491-3000"
}
],
"practiceLocations": [
{
"address_1": "3900 Lakeville Hwy",
"address_purpose": "LOCATION",
"city": "Petaluma",
"state": "CA",
"postal_code": "949545698",
"country_code": "US",
"telephone_number": "707-765-3900",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MARTIN",
"first_name": "SHEDRICK",
"credential": "PHARMD, BCPP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-19",
"last_updated": "2022-10-24",
"certification_date": "2022-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "CA",
"license": "77539",
"primary": false
},
{
"code": "1835P1200X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacotherapy",
"state": "CA",
"license": "7539",
"primary": false
},
{
"code": "1835P1300X",
"taxonomy_group": "",
"desc": "Pharmacist, Psychiatric",
"state": "CA",
"license": "77539",
"primary": false
},
{
"code": "1835P2201X",
"taxonomy_group": "",
"desc": "Pharmacist, Ambulatory Care",
"state": "CA",
"license": "77539",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "77539",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.