Provider Demographics
NPI:1396793055
Name:PELGER, MARTIN FREDERICK (RPH)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:FREDERICK
Last Name:PELGER
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 1:6901 N OZONA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-1230
Mailing Address - Country:US
Mailing Address - Phone:520-323-3573
Mailing Address - Fax:
Practice Address - Street 1:1295 N. MARTIN AVE
Practice Address - Street 2:B207
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85721-0001
Practice Address - Country:US
Practice Address - Phone:520-626-3947
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8633183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist