Provider Demographics
NPI:1922279066
Name:MARTEN, MARYBETH (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:MARTEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15437 N 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4004
Mailing Address - Country:US
Mailing Address - Phone:602-938-1473
Mailing Address - Fax:
Practice Address - Street 1:4249 W GLENDALE AVE
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-8137
Practice Address - Country:US
Practice Address - Phone:623-937-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13800183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist