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General NPI Number Information
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NPI Number | 1881310282
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Entity Type | Organization
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Legal Business Name | HAZEN HEALTH PHARMACY
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 30 MAIN ST W
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City | HAZEN
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State | ND
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Zip | 58545-4205
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Country | US
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Telephone | 701-748-2312
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Fax | 701-748-2637
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Provider Business Mailing Address
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Address Line | PO BOX 669
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City | HAZEN
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State | ND
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Zip | 58545-0669
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Country | US
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Telephone | 701-748-2312
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Fax | 701-748-2637
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | WYATT ELDON MARTENSON
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Credential | PHARMD
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Telephone | 701-873-5215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336L0003X
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Taxonomy Name | Long Term Care Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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