Healthcare Provider Details

I. General information

NPI: 1346791555
Provider Name (Legal Business Name): JENNIFER ANN MARTINEAU RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2016
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N SCOTTSDALE RD
SCOTTSDALE AZ
85253
US

IV. Provider business mailing address

1031 N HWY 89
CHINO VALLEY AZ
86323-5978
US

V. Phone/Fax

Practice location:
  • Phone: 480-822-6197
  • Fax:
Mailing address:
  • Phone: 928-636-8358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023404
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: