Healthcare Provider Details

I. General information

NPI: 1336146489
Provider Name (Legal Business Name): MARTHA PATRICIA FANKHAUSER PHARM. M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N OLSEN AVE
TUCSON AZ
85719-5138
US

IV. Provider business mailing address

721 N OLSEN AVE
TUCSON AZ
85719-5138
US

V. Phone/Fax

Practice location:
  • Phone: 520-405-6526
  • Fax:
Mailing address:
  • Phone: 520-884-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number7311
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: