Provider Demographics
NPI:1619401437
Name:RICH, MARTIN WELLS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:WELLS
Last Name:RICH
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 1:5330 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85034-2140
Mailing Address - Country:US
Mailing Address - Phone:602-732-3384
Mailing Address - Fax:
Practice Address - Street 1:1985 E CHANDLER BLVD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5110
Practice Address - Country:US
Practice Address - Phone:480-899-8050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022412183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist