Provider Demographics
NPI:1134137516
Name:MARTIN, BETH A (RPH, PHD)
Entity Type:Individual
Prefix:PROF
First Name:BETH
Middle Name:A
Last Name:MARTIN
Suffix:
Gender:F
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 HIGHLAND AVE
Mailing Address - Street 2:1022 RENNEBOHM HALL
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2222
Mailing Address - Country:US
Mailing Address - Phone:608-265-4667
Mailing Address - Fax:608-265-5421
Practice Address - Street 1:777 HIGHLAND AVE
Practice Address - Street 2:1022 RENNEBOHM HALL
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2222
Practice Address - Country:US
Practice Address - Phone:608-265-4667
Practice Address - Fax:608-265-5421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11543183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist