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NPI Code Detail

MEDICARE: DR. MARDOQUEO JOSEPH MARTINEZ III PHARMD

MEDICARE: DR. MARDOQUEO JOSEPH MARTINEZ III PHARMD
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
1183500000XPharmacistS021461AZ

General Provider Information

NPI Number : 1760868996
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARDOQUEO JOSEPH MARTINEZ III PHARMD
Provider Business Mailing Address
First Line : 5901 W BEHREND DR
Second Line : APT 3107
City : GLENDALE
State : AZ
Zip : 85308-6943
Country : US
Telephone Number : 505-249-7154
Fax Number :
Provider Business Practice Location Address
First Line : 19389 N 59TH AVE
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-6500
Country : US
Telephone Number : 623-537-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 08/11/2015

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