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General NPI Number Information
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NPI Number | 1619963758
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Entity Type | Individual
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Provider Name | GLENN ERIC MARTINEZ BS PHARM, PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/23/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | JOHN COCHRAN VA MEDICAL CENTER 915 NORTH GRAND
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City | ST. LOUIS
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State | MO
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Zip | 63106
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Country | US
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Telephone | 314-289-6339
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Fax |
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Provider Business Mailing Address
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Address Line | 375 BECKLEY PL
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City | SAINT CHARLES
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State | MO
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Zip | 63304-1030
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Country | US
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Telephone | 636-577-7369
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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 | PS 39822
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License Number State | FL
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