Provider Demographics
NPI:1356433387
Name:DEMARTINI, DAVID ALAN (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:DEMARTINI
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 1:10645 JAMES LN
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-3407
Mailing Address - Country:US
Mailing Address - Phone:530-273-2268
Mailing Address - Fax:530-273-5987
Practice Address - Street 1:102 CATHERINE LN
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-5701
Practice Address - Country:US
Practice Address - Phone:530-273-2268
Practice Address - Fax:530-273-5987
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH29730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist