Healthcare Provider Details

I. General information

NPI: 1184904344
Provider Name (Legal Business Name): MARTINA N WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 08/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 E ROUTE 130 S
BURLINGTON NJ
08016-2774
US

IV. Provider business mailing address

4700 CITY AVE APT 10303
PHILADELPHIA PA
19131
US

V. Phone/Fax

Practice location:
  • Phone: 609-387-4998
  • Fax:
Mailing address:
  • Phone: 215-237-9768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03387900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: