Provider Demographics
NPI:1255501391
Name:MAARTENS, ELIZABETH MARTHA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARTHA
Last Name:MAARTENS
Suffix:
Gender:F
Credentials:
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 52003
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-7003
Mailing Address - Country:US
Mailing Address - Phone:831-375-8900
Mailing Address - Fax:
Practice Address - Street 1:1301 MUNRAS AVE
Practice Address - Street 2:DEL MONTE CENTRE
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940
Practice Address - Country:US
Practice Address - Phone:831-375-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH58907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist