Provider Demographics
NPI:1528061025
Name:JAGERS, MARTIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:JAGERS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7403 NDCBU
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571
Mailing Address - Country:US
Mailing Address - Phone:505-737-5361
Mailing Address - Fax:
Practice Address - Street 1:1202 N RIVERSIDE DR
Practice Address - Street 2:CVS PHARMACY
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2976
Practice Address - Country:US
Practice Address - Phone:505-367-3594
Practice Address - Fax:505-367-0805
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist