Healthcare Provider Details

I. General information

NPI: 1467949370
Provider Name (Legal Business Name): MARIE MARTINEZ PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 04/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N VERMONT AVE STE 237
LOS ANGELES CA
90027-5337
US

IV. Provider business mailing address

2245 SINALOA AVE
ALTADENA CA
91001-3313
US

V. Phone/Fax

Practice location:
  • Phone: 323-783-6458
  • Fax:
Mailing address:
  • Phone: 626-675-7607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberRPH58624
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: