Provider Demographics
NPI:1194026633
Name:ANDERSON, MARTELL DEAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTELL
Middle Name:DEAN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 GAMBELL ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-4630
Mailing Address - Country:US
Mailing Address - Phone:907-339-0260
Mailing Address - Fax:907-339-0219
Practice Address - Street 1:1340 GAMBELL ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4630
Practice Address - Country:US
Practice Address - Phone:907-339-0260
Practice Address - Fax:907-339-0219
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist