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NPI Code Detail

MEDICARE: LARISSA MARTINS

MEDICARE: LARISSA MARTINS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist63183FL

General Provider Information

NPI Number : 1336818798
Entity Type Code : Individual
Provider Name (Legal Business Name) : LARISSA MARTINS
Provider Business Mailing Address
First Line : 4740 CYPRESS GARDENS LOOP UNIT 9102
Second Line :
City : FORT MYERS
State : FL
Zip : 33966-7064
Country : US
Telephone Number : 239-896-5174
Fax Number :
Provider Business Practice Location Address
First Line : 11851 PALM BEACH BLVD
Second Line :
City : FORT MYERS
State : FL
Zip : 33905-5912
Country : US
Telephone Number : 239-896-5174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2021
Last Update Date : 09/09/2021

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Directions to “ LARISSA MARTINS ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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