Provider Demographics
NPI:1336146489
Name:FANKHAUSER, MARTHA PATRICIA (PHARM MS)
Entity Type:Individual
Prefix:PROF
First Name:MARTHA
Middle Name:PATRICIA
Last Name:FANKHAUSER
Suffix:
Gender:F
Credentials:PHARM MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N OLSEN AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-5138
Mailing Address - Country:US
Mailing Address - Phone:520-884-9091
Mailing Address - Fax:
Practice Address - Street 1:721 N OLSEN AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-5138
Practice Address - Country:US
Practice Address - Phone:520-405-6526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73111835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric