Provider Demographics
NPI:1578831236
Name:WDOWICKI, MARTHA A (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:A
Last Name:WDOWICKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 FIELDSTONE LNDG
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4198
Mailing Address - Country:US
Mailing Address - Phone:770-410-9690
Mailing Address - Fax:
Practice Address - Street 1:465 FIELDSTONE LNDG
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4198
Practice Address - Country:US
Practice Address - Phone:770-410-9690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH017886183500000X
FLPS46622183500000X
FLPU67481835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist