Healthcare Provider Details

I. General information

NPI: 1639791809
Provider Name (Legal Business Name): ALLYSSA MARTINEZ CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 EUCLID AVE
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

5392 CORNELL BLVD
NORTH RIDGEVILLE OH
44039-1904
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-8950
  • Fax:
Mailing address:
  • Phone: 216-527-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number09313246
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: