Provider Demographics
NPI:1528781119
Name:MARTEN, MICHELLE JEAN (PHARM D)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:JEAN
Last Name:MARTEN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:JEAN
Other - Last Name:SHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:112 SAWMILL ROAD
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634
Mailing Address - Country:US
Mailing Address - Phone:406-799-8715
Mailing Address - Fax:406-500-2133
Practice Address - Street 1:1930 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-500-2080
Practice Address - Fax:406-500-2133
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT119303336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy