Provider Demographics
NPI:1770859142
Name:PELTZ, MARTIN LEONARD (RPH)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:LEONARD
Last Name:PELTZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:MR
Other - First Name:MARTIN
Other - Middle Name:LEONARD
Other - Last Name:PELTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:37847 AMBER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1171
Mailing Address - Country:US
Mailing Address - Phone:248-553-9286
Mailing Address - Fax:
Practice Address - Street 1:2343 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48302-0254
Practice Address - Country:US
Practice Address - Phone:248-972-0725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist