Provider Demographics
NPI:1700085800
Name:MARTINSON, BARRY WILLIAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:WILLIAM
Last Name:MARTINSON
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 1:221 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-2704
Mailing Address - Country:US
Mailing Address - Phone:218-740-2650
Mailing Address - Fax:218-740-3443
Practice Address - Street 1:221 E 14TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811-2704
Practice Address - Country:US
Practice Address - Phone:218-740-2650
Practice Address - Fax:218-740-3443
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN111363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist