Provider Demographics
NPI:1669923751
Name:AKESON, MARTINA ALEXANDER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTINA
Middle Name:ALEXANDER
Last Name:AKESON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6348 NE HALSEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-4720
Mailing Address - Country:US
Mailing Address - Phone:503-962-1700
Mailing Address - Fax:
Practice Address - Street 1:6348 NE HALSEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4720
Practice Address - Country:US
Practice Address - Phone:503-962-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH-0010451183500000X
WVRP0009699183500000X
MI5302045065183500000X
OK17106183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist