Provider Demographics
NPI:1639495518
Name:WILLEMS, MARTIN JARROD (RPH)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:JARROD
Last Name:WILLEMS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE NORTH
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101
Mailing Address - Country:US
Mailing Address - Phone:406-245-6717
Mailing Address - Fax:406-252-4078
Practice Address - Street 1:2900 12TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101
Practice Address - Country:US
Practice Address - Phone:406-245-6717
Practice Address - Fax:406-252-4078
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist