Healthcare Provider Details

I. General information

NPI: 1457716664
Provider Name (Legal Business Name): RAYMOND MARTINEZ PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7847 TRAMWAY NE
ALBUQUERQUE NM
87122
US

IV. Provider business mailing address

6480 MONTE SERRANO NE
ALBUQUERQUE NM
87111-1285
US

V. Phone/Fax

Practice location:
  • Phone: 505-821-5422
  • Fax:
Mailing address:
  • Phone: 505-314-4933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00008382
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: