Provider Demographics
NPI:1487178661
Name:MARTZ, DESMOND ERIC (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:DESMOND
Middle Name:ERIC
Last Name:MARTZ
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 1:8 TAMARACK LN
Mailing Address - Street 2:
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1911
Mailing Address - Country:US
Mailing Address - Phone:518-414-1075
Mailing Address - Fax:
Practice Address - Street 1:139 MERCHANT PL
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5715
Practice Address - Country:US
Practice Address - Phone:518-234-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063079183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist