Provider Demographics
NPI:1942237185
Name:MORIN, MARTHA (RPH)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:MORIN
Suffix:
Gender:F
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:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:IA
Mailing Address - Zip Code:51001-0800
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 REED ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:IA
Practice Address - Zip Code:51001
Practice Address - Country:US
Practice Address - Phone:712-568-2013
Practice Address - Fax:712-568-2711
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA457183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0036731Medicaid
IA0036731Medicaid