Active NPI
Kenneth Martin, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Brandon, MS
National Provider Identifier
1467085274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- E-7098
- Practice address
- 1811 West Govt St
Brandon, MS 39042-2106 - Phone
- (601) 828-3773
- NPI assigned
- Feb 20, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | E-7098 | MS | Primary |
Addresses
Primary practice location
1811 West Govt St
Brandon, MS 39042-2106
Mailing address
100 Greenbrook Dr
Brandon, MS 39042-2106
Phone (601) 540-2121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E-7098 | Other | MS | MS BOARD OF PHARMACY |
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
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-7098 | MS | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1582156800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582156800000",
"number": "1467085274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 GREENBROOK DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390422106",
"telephone_number": "601-540-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1811 WEST GOVT ST",
"city": "BRANDON",
"state": "MS",
"postal_code": "390422106",
"telephone_number": "601-828-3773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "KENNETH",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-02-20",
"last_updated": "2020-02-20",
"certification_date": "2020-02-20",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "MS",
"license": "E-7098",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MS BOARD OF PHARMACY",
"identifier": "E-7098",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.