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General NPI Number Information
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NPI Number | 1629470604
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Entity Type | Individual
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Provider Name | HERMAN E MARTINEZ PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2014
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 1 KISH HOSPITAL DR
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City | DEKALB
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State | IL
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Zip | 60115-9602
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Country | US
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Telephone | 815-756-1521
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Fax |
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Provider Business Mailing Address
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Address Line | 2216 OAKRIDGE DR APT. 14
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City | AURORA
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State | IL
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Zip | 60502-4525
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Country | US
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Telephone | 561-685-3512
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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 | 051298096
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License Number State | IL
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