Provider Demographics
NPI:1871130328
Name:MARTIN, FRIEDA MARTHA (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:FRIEDA
Middle Name:MARTHA
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:FRIEDA
Other - Middle Name:MARTHA
Other - Last Name:HABIBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 E COSTILLA ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3764
Mailing Address - Country:US
Mailing Address - Phone:719-596-4449
Mailing Address - Fax:719-574-6686
Practice Address - Street 1:555 E COSTILLA ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3764
Practice Address - Country:US
Practice Address - Phone:719-596-4449
Practice Address - Fax:719-574-6686
Is Sole Proprietor?:No
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO144851835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist