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General NPI Number Information
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NPI Number | 1841576345
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Entity Type | Individual
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Provider Name | JORGE ANTONIO MARTILLO R.PH
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Gender | Male
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Dates
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Enumeration Date | 10/27/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 7151 BOULEVARD 26 ( WALGREENS )
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City | NORTH RICHLAND HILLS
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State | TX
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Zip | 76180-8607
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Country | US
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Telephone | 817-514-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 700 HILL TRAIL DR APT 1025
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City | EULESS
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State | TX
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Zip | 76039-5686
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Country | US
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Telephone | 718-926-3432
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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 | 47343
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 044133
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License Number State | NY
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