Organization · Type 2 NPI

Martin Memorial Physician Corporation, Inc

Community/Retail Pharmacy · Port St. Lucie, FL

NPI number 1407365513 Active

Practice location

10080 SW Innovation Way Ste 102
Port St. Lucie, FL 34987-2129

Fax (772) 345-8167

Specialties and licenses

Taxonomy	Code	License
Community/Retail Pharmacy Primary	3336C0003X	PH30943 (FL)

Community/Retail Pharmacy: A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other …

3 other providers at this address

Other community/retail pharmacy providers in Port St. Lucie

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NPI record

NPI: 1407365513
Entity type: Organization (Type 2)
Issued: Sep 21, 2017
Last updated: Dec 8, 2022
Status: Active

Other names

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MHPG Tradition Pharmacy at Martin Health · doing business as

Authorized official

Timothy L. Longville
Chief Accounting Officer/controller
(216) 636-7416

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1407365513

Martin Memorial Physician Corporation, Inc's National Provider Identifier is 1407365513, issued on Sep 21, 2017. The primary taxonomy on file is Community/Retail Pharmacy (3336C0003X), and the practice location is in Port St. Lucie, FL. The record was last updated on Dec 8, 2022.