Provider Demographics
NPI:1689958563
Name:MARTI, RYAN LEE (RPH, PHARMD, AAHIVP)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:LEE
Last Name:MARTI
Suffix:
Gender:M
Credentials:RPH, PHARMD, AAHIVP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 BLAKE WILBUR DR STE CC1102
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2205
Mailing Address - Country:US
Mailing Address - Phone:650-736-3800
Mailing Address - Fax:650-736-7991
Practice Address - Street 1:875 BLAKE WILBUR DR STE CC1102
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-2205
Practice Address - Country:US
Practice Address - Phone:650-736-3800
Practice Address - Fax:650-736-7991
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66168183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist