Provider Demographics
NPI:1417391822
Name:NEILL, MARTA L
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:L
Last Name:NEILL
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 1:374 SAXONY RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9298
Mailing Address - Country:US
Mailing Address - Phone:970-218-9042
Mailing Address - Fax:303-698-8975
Practice Address - Street 1:1220 S LIPAN ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80223-3069
Practice Address - Country:US
Practice Address - Phone:303-698-8971
Practice Address - Fax:303-698-8975
Is Sole Proprietor?:No
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO13149183500000X
IA17184183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist