Healthcare Provider Details

I. General information

NPI: 1194132274
Provider Name (Legal Business Name): RAMON MARTINEZ RPH, PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

571 WALTON BLVD
LAS CRUCES NM
88001-8449
US

IV. Provider business mailing address

7389 VISTA DE SOBRE DR
LAS CRUCES NM
88012-0775
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-3501
  • Fax: 575-524-0066
Mailing address:
  • Phone: 915-873-1340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP6940
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: