Active NPI
Andrea Maxine Martin, PHARMD
- Pharmacist
- Niles, MI
National Provider Identifier
1861818445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 5302034431
- Practice address
- 907 S 11TH St
Niles, MI 49120-3402 - Phone
- (269) 683-0234
- NPI assigned
- Mar 6, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 5302034431 | MI | Primary |
| Pharmacist | 183500000X | PS34098 | FL | |
| Pharmacist | 183500000X | 26020956A | IN |
Addresses
Primary practice location
907 S 11TH St
Niles, MI 49120-3402
Mailing address
907 S 11TH St
Niles, MI 49120-3402
Phone (269) 683-0234
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 |
|---|---|---|---|
| 26020956A | IN | MD | Pharmacist |
| 5302034431 | MI | MD | Pharmacist |
| PS34098 | FL | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pharmacy
- Niles, MI
- NPI 1437164548
-
- Pharmacy
- Longview, TX
- NPI 1629956545
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1394064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394064000000",
"number": "1861818445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "907 S 11TH ST",
"city": "NILES",
"state": "MI",
"postal_code": "491203402",
"telephone_number": "269-683-0234"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "907 S 11TH ST",
"city": "NILES",
"state": "MI",
"postal_code": "491203402",
"telephone_number": "269-683-0234"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "ANDREA",
"middle_name": "MAXINE",
"name_prefix": "Dr.",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-03-06",
"last_updated": "2014-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MI",
"license": "5302034431",
"primary": true
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS34098",
"primary": false
},
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26020956A",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Niles, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.