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General NPI Number Information
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NPI Number | 1447465638
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Entity Type | Individual
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Provider Name | STANLEY MARTKA R.PH.
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Gender | Male
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1737 CLARKSON RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017-4977
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Country | US
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Telephone | 636-532-6060
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Fax | 636-532-5001
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Provider Business Mailing Address
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Address Line | 18422 WOODLAND MEADOWS DR
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City | WILDWOOD
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State | MO
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Zip | 63038-1814
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Country | US
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Telephone | 636-458-4635
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 029464
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License Number State | MO
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