Provider Demographics
NPI:1609485234
Name:MCMARTIN, JALEN EVAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:JALEN
Middle Name:EVAN
Last Name:MCMARTIN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 ROCKSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53546-3314
Mailing Address - Country:US
Mailing Address - Phone:608-322-5941
Mailing Address - Fax:
Practice Address - Street 1:808 S DULUTH AVE
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3807
Practice Address - Country:US
Practice Address - Phone:920-746-5245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20371-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist