Provider Demographics
NPI:1376843466
Name:MARTINI, JERRY RICHARD (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:RICHARD
Last Name:MARTINI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6732 S VERNON DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-4681
Mailing Address - Country:US
Mailing Address - Phone:480-883-9284
Mailing Address - Fax:480-883-0270
Practice Address - Street 1:4970 S ALMA SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-5502
Practice Address - Country:US
Practice Address - Phone:480-883-0260
Practice Address - Fax:480-883-0270
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-24
Last Update Date:2010-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS012544183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist