MEDICARE: JAZZSMEN NICOLE MARTINEZ CPHT

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
1	183700000X	Pharmacy Technician

General Provider Information

NPI Number	:	1477142636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZZSMEN NICOLE MARTINEZ CPHT

Provider Business Mailing Address
First Line	:	100 CARLOS G PARKER BLVD NW STE 101
Second Line	:
City	:	TAYLOR
State	:	TX
Zip	:	76574-7059
Country	:	US
Telephone Number	:	512-352-2024
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CARLOS G PARKER BLVD NW STE 101
Second Line	:
City	:	TAYLOR
State	:	TX
Zip	:	76574-7059
Country	:	US
Telephone Number	:	512-352-2024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	01/12/2021

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Directions to “ JAZZSMEN NICOLE MARTINEZ CPHT” Practice Location

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