Provider Demographics
NPI:1447567029
Name:HARTMAN, MARTA ANN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MARTA
Middle Name:ANN
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3355 E PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-5764
Mailing Address - Country:US
Mailing Address - Phone:307-635-1156
Mailing Address - Fax:307-632-5657
Practice Address - Street 1:3355 E PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-5764
Practice Address - Country:US
Practice Address - Phone:307-635-1156
Practice Address - Fax:307-632-5657
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2354183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist