Provider Demographics
NPI:1043921000
Name:MARTENSON, WYATT ELDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:WYATT
Middle Name:ELDON
Last Name:MARTENSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1848 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:BEULAH
Mailing Address - State:ND
Mailing Address - Zip Code:58523-7012
Mailing Address - Country:US
Mailing Address - Phone:701-361-9689
Mailing Address - Fax:
Practice Address - Street 1:147 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BEULAH
Practice Address - State:ND
Practice Address - Zip Code:58523-6969
Practice Address - Country:US
Practice Address - Phone:701-873-5215
Practice Address - Fax:701-873-4908
Is Sole Proprietor?:No
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH5978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist