Provider Demographics
NPI:1457963720
Name:ASHINE, MARTHA B (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:B
Last Name:ASHINE
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MRS
Other - First Name:MARTHA
Other - Middle Name:B
Other - Last Name:WILLS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16395 WAGNER WAY
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5754
Mailing Address - Country:US
Mailing Address - Phone:952-937-2934
Mailing Address - Fax:
Practice Address - Street 1:16395 WAGNER WAY
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-5754
Practice Address - Country:US
Practice Address - Phone:952-937-2934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN124602183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist