Provider Demographics
NPI:1396377248
Name:TCHAFACK KAZE, JOEL MARTIAL MARTIAL
Entity Type:Individual
Prefix:
First Name:JOEL MARTIAL
Middle Name:MARTIAL
Last Name:TCHAFACK KAZE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N CANAL ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-5107
Mailing Address - Country:US
Mailing Address - Phone:575-941-0250
Mailing Address - Fax:
Practice Address - Street 1:801 N CANAL ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5107
Practice Address - Country:US
Practice Address - Phone:575-941-0250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-09
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00009244183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist