Provider Demographics
NPI:1225135676
Name:MARTINEZ, JACQUELINE FACENDA (PHARM D)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:FACENDA
Last Name: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 1:8480 TALLAHASSEE DR NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2738
Mailing Address - Country:US
Mailing Address - Phone:727-576-6564
Mailing Address - Fax:
Practice Address - Street 1:10,000 BAY PINES BLVD
Practice Address - Street 2:PHY SERVICE #119
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0031576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist