Provider Demographics
NPI:1447465638
Name:MARTKA, STANLEY (RPH)
Entity type:Individual
Prefix:
First Name:STANLEY
Middle Name:
Last Name:MARTKA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18422 WOODLAND MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63038-1814
Mailing Address - Country:US
Mailing Address - Phone:636-458-4635
Mailing Address - Fax:
Practice Address - Street 1:1737 CLARKSON RD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-4977
Practice Address - Country:US
Practice Address - Phone:636-532-6060
Practice Address - Fax:636-532-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029464183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist