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General NPI Number Information
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NPI Number | 1609485234
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Entity Type | Individual
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Provider Name | JALEN EVAN MCMARTIN PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2020
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 808 S DULUTH AVE
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City | STURGEON BAY
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State | WI
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Zip | 54235-3807
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Country | US
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Telephone | 920-746-5245
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Fax |
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Provider Business Mailing Address
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Address Line | 702 ROCKSHIRE DR
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City | JANESVILLE
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State | WI
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Zip | 53546-3314
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Country | US
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Telephone | 608-322-5941
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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 | 20371-40
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License Number State | WI
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