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
- Last updated
- 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 |
|---|---|---|---|
| PS34098 | FL | MD | Pharmacist |
| 26020956A | IN | MD | Pharmacist |
| 5302034431 | MI | MD | Pharmacist |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
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
- Annette Marguerite Mangold
- Stephanie Marie Mann
- John-Phillip Thomas Markovic, MD
- Alex Markovich, MS PT
- Ross Francis Maroney, RPH
- Martin's Super Markets of Niles LLC (Martin's Pharmacy #19)
- Kelly Martinczak, LLSW, LSW
- Mary Patricia McManmon MD PC (Advanced Wellness Clinic)
- Brianna Matamoros-Morales
- Victoria Matamoros-Morales
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.