Provider Demographics
NPI:1093786030
Name:TJOLSEN, MARTHA LINCOLN (BS PHARMACY)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:LINCOLN
Last Name:TJOLSEN
Suffix:
Gender:F
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3016 WINDMILL CT
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-8201
Mailing Address - Country:US
Mailing Address - Phone:517-263-7300
Mailing Address - Fax:517-263-7370
Practice Address - Street 1:75 E BENNETT ST
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-1204
Practice Address - Country:US
Practice Address - Phone:734-429-0509
Practice Address - Fax:734-944-1180
Is Sole Proprietor?:No
Enumeration Date:2006-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302025291183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist