Provider Demographics
NPI:1730493123
Name:WIRTH, MARTIN G (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:G
Last Name:WIRTH
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 1:162 CROTON AVE
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4430
Mailing Address - Country:US
Mailing Address - Phone:914-941-1660
Mailing Address - Fax:914-941-1236
Practice Address - Street 1:162 CROTON AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4430
Practice Address - Country:US
Practice Address - Phone:914-941-1660
Practice Address - Fax:914-941-1236
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY52357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist