1164802005 NPI number — MRS. KATHRYN FARLEY MARTIN RPH

Table of content: MRS. KATHRYN FARLEY MARTIN RPH (NPI 1164802005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164802005 NPI number — MRS. KATHRYN FARLEY MARTIN RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
KATHRYN
Provider Middle Name:
FARLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164802005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2275 EDMONSON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUCAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75002-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-287-1346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3313 ESSEX DR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-765-5456
Provider Business Practice Location Address Fax Number:
214-765-5477
Provider Enumeration Date:
06/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  42750 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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