Provider Demographics
NPI:1376877654
Name:MARTINEZ, FELIPE
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PHILLIP
Other - Middle Name:C
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:100 E HWY 550
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5967
Mailing Address - Country:US
Mailing Address - Phone:505-867-6071
Mailing Address - Fax:
Practice Address - Street 1:100 E HWY 550
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5967
Practice Address - Country:US
Practice Address - Phone:505-867-6071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-20
Last Update Date:2009-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM6081183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist