Provider Demographics
NPI:1174817738
Name:DE JESUS MARTINEZ, JACLYN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:DE JESUS MARTINEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PLAZA MONTE REAL CARR 2 KM 45.8
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-884-0007
Mailing Address - Fax:787-854-6705
Practice Address - Street 1:PLAZA MONTE REAL CARR 2 KM 45.8
Practice Address - Street 2:
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674
Practice Address - Country:US
Practice Address - Phone:787-884-0007
Practice Address - Fax:787-854-6705
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist