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General NPI Number Information
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NPI Number | 1396620472
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Entity Type | Individual
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Provider Name | RANDY MARTINEZ RPH
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Gender | Male
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 20 YORK ST
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City | NEW HAVEN
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State | CT
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Zip | 06510-3220
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Country | US
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Telephone | 203-688-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 97 WINDY DR
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City | WATERBURY
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State | CT
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Zip | 06705-2515
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Country | US
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Telephone | 203-592-8132
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PCT.0017100
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License Number State | CT
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