Provider Demographics
NPI:1033799952
Name:MARTINEZ DE ANDINO, ANA IVELISSE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANA IVELISSE
Middle Name:
Last Name:MARTINEZ DE ANDINO
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:ANA IVELISSE
Other - Middle Name:
Other - Last Name:MARTINEZ DE ANDINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:2117 CALLE LERNA
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4936
Mailing Address - Country:US
Mailing Address - Phone:787-512-5373
Mailing Address - Fax:
Practice Address - Street 1:733 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00920-5004
Practice Address - Country:US
Practice Address - Phone:787-783-4285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2929183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist