Provider Demographics
NPI:1730438953
Name:MARTIN, DANA J (PD01)
Entity type:Individual
Prefix:MR
First Name:DANA
Middle Name:J
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PD01
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-7159
Mailing Address - Country:US
Mailing Address - Phone:985-876-9494
Mailing Address - Fax:985-876-9494
Practice Address - Street 1:1401 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-2734
Practice Address - Country:US
Practice Address - Phone:504-834-1570
Practice Address - Fax:504-833-9148
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist