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NPI Code Detail

MEDICARE: TOM MAERTENS

MEDICARE: TOM MAERTENS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist2705WY

General Provider Information

NPI Number : 1639651417
Entity Type Code : Individual
Provider Name (Legal Business Name) : TOM MAERTENS
Provider Business Mailing Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number :
Provider Business Practice Location Address
First Line : 431 FORT ST
Second Line :
City : BUFFALO
State : WY
Zip : 82834-1805
Country : US
Telephone Number : 307-684-7003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2018
Last Update Date : 08/29/2018

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Directions to “ TOM MAERTENS ” Practice Location

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