Provider Demographics
NPI:1386856953
Name:MARTI, GLENDA L
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:L
Last Name:MARTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 7 BOX 32047
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-9319
Mailing Address - Country:US
Mailing Address - Phone:787-820-4630
Mailing Address - Fax:787-898-1859
Practice Address - Street 1:CARR 492 KM 2.3
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-820-4747
Practice Address - Fax:787-898-1859
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3832183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3832OtherLIC AUXILIAR DE FARMACIA