Provider Demographics
NPI:1184221822
Name:MARTIN, AMANDO CRUZ JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:AMANDO
Middle Name:CRUZ
Last Name:MARTIN
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MIRABELLA
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-4175
Mailing Address - Country:US
Mailing Address - Phone:877-778-3773
Mailing Address - Fax:800-951-7948
Practice Address - Street 1:132 S ANITA DR FL 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3317
Practice Address - Country:US
Practice Address - Phone:877-778-3773
Practice Address - Fax:800-951-7948
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist