Provider Demographics
NPI:1881310282
Name:HAZEN HEALTH PHARMACY
Entity type:Organization
Organization Name:HAZEN HEALTH PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WYATT
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:MARTENSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:701-873-5215
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-0669
Mailing Address - Country:US
Mailing Address - Phone:701-748-2312
Mailing Address - Fax:701-748-2637
Practice Address - Street 1:30 MAIN ST W
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4205
Practice Address - Country:US
Practice Address - Phone:701-748-2312
Practice Address - Fax:701-748-2637
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEULAH DRUG COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-17
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy