Provider Demographics
NPI:1487931499
Name:KAPEGHIAN, MARTHA HOLLEMAN
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:HOLLEMAN
Last Name:KAPEGHIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14240 VIA CONTENTO CT
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-6646
Mailing Address - Country:US
Mailing Address - Phone:775-750-1181
Mailing Address - Fax:775-853-5401
Practice Address - Street 1:18144 WEDGE PKWY
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-8168
Practice Address - Country:US
Practice Address - Phone:775-850-8290
Practice Address - Fax:775-850-8933
Is Sole Proprietor?:No
Enumeration Date:2011-11-05
Last Update Date:2011-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV13961183500000X
MSE-06900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist