Active NPI
Justin Martin
- Pharmacist
- Fond Du Lac, WI
National Provider Identifier
1902250301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 17716-40
- Practice address
- 145 N Main St
Fond Du Lac, WI 54935-3423 - Phone
- (920) 926-4660
- NPI assigned
- Apr 21, 2016
- Sex
- Male
- Sole proprietor
- No
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 | 183500000X | 17716-40 | WI | Primary |
Addresses
Primary practice location
145 N Main St
Fond Du Lac, WI 54935-3423
Mailing address
145 N Main St
Fond Du Lac, WI 54935-3423
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17716-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661212800000",
"number": "1902250301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 N MAIN ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 N MAIN ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549353423",
"telephone_number": "920-926-4660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "JUSTIN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-04-21",
"last_updated": "2022-08-23",
"certification_date": "2022-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "17716-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.