Healthcare Provider Details

I. General information

NPI: 1215418421
Provider Name (Legal Business Name): LOUIS PIERRE MARTINEZ RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2018
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122-02 LIBERTY AVE
SOUTH RICHMOND HILL NY
11419-2114
US

IV. Provider business mailing address

253 CLEVELAND ST
FRANKLIN SQUARE NY
11010-2310
US

V. Phone/Fax

Practice location:
  • Phone: 718-843-7001
  • Fax:
Mailing address:
  • Phone: 646-623-2988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number064257
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: