Provider Demographics
NPI:1144076423
Name:MARTIN, TASIA (PHARMD)
Entity type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:MARTIN
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 1:18 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PIMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85543-0030
Mailing Address - Country:US
Mailing Address - Phone:928-485-4315
Mailing Address - Fax:
Practice Address - Street 1:18 W CENTER ST
Practice Address - Street 2:
Practice Address - City:PIMA
Practice Address - State:AZ
Practice Address - Zip Code:85543-0030
Practice Address - Country:US
Practice Address - Phone:928-485-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS026940183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist