1851612832 NPI number — MRS. ASHLEY ANNE MARTIN PHARMD

Table of content: MRS. ASHLEY ANNE MARTIN PHARMD (NPI 1851612832)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851612832 NPI number — MRS. ASHLEY ANNE MARTIN PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
ASHLEY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MILES
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851612832
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W BROADWAY, 3RD FLOOR
Provider Second Line Business Mailing Address:
WOMEN'S CARE CENTER/CARDIOMETABOLIC CENTER
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-329-4121
Provider Business Mailing Address Fax Number:
406-327-3231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W BROADWAY, 3RD FLOOR
Provider Second Line Business Practice Location Address:
WOMEN'S CARE CENTER/CARDIOMETABOLIC CENTER
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-329-4121
Provider Business Practice Location Address Fax Number:
406-327-3231
Provider Enumeration Date:
06/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  6226 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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