Provider Demographics
NPI:1225373798
Name:MARTY, ZACHARY JOHN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:JOHN
Last Name:MARTY
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:PO BOX 759
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0759
Mailing Address - Country:US
Mailing Address - Phone:701-477-1945
Mailing Address - Fax:
Practice Address - Street 1:213 3RD ST NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7140
Practice Address - Country:US
Practice Address - Phone:701-477-1945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDRPH55201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist