Provider Demographics
NPI:1871614867
Name:KUNKLE, MARTHA (RPH)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:KUNKLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-2201
Mailing Address - Country:US
Mailing Address - Phone:515-270-2225
Mailing Address - Fax:515-270-2227
Practice Address - Street 1:8601 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-2201
Practice Address - Country:US
Practice Address - Phone:515-270-2225
Practice Address - Fax:515-270-2227
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15519183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA15519OtherPHARMACY LIC. #