Healthcare Provider Details

I. General information

NPI: 1558271619
Provider Name (Legal Business Name): JESSICA MARTINEZ RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7190 HIGHWAY 165
COLUMBIA LA
71418-3302
US

IV. Provider business mailing address

PO BOX 1208
COLUMBIA LA
71418-1208
US

V. Phone/Fax

Practice location:
  • Phone: 318-649-0825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPST.016244
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: