Provider Demographics
NPI:1255611893
Name:DENSCH, MARTIN (RPH)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DENSCH
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 1:2796 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3981
Mailing Address - Country:US
Mailing Address - Phone:608-774-8655
Mailing Address - Fax:
Practice Address - Street 1:1531 MADISON RD
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3267
Practice Address - Country:US
Practice Address - Phone:608-365-1904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9381-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist