Provider Demographics
NPI:1376622597
Name:MARTINEZ, EDITH I (RPH)
Entity Type:Individual
Prefix:MS
First Name:EDITH
Middle Name:I
Last Name:MARTINEZ
Suffix:
Gender:F
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:PO BOX 2020
Mailing Address - Street 2:PMB 159
Mailing Address - City:BARCELONETA
Mailing Address - State:PR
Mailing Address - Zip Code:00617-2020
Mailing Address - Country:US
Mailing Address - Phone:787-485-6477
Mailing Address - Fax:
Practice Address - Street 1:22 CALLE PALMER
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3233
Practice Address - Country:US
Practice Address - Phone:787-871-2155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist