Provider Demographics
NPI:1417086190
Name:VELASQUEZ, MARTA M
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:M
Last Name:VELASQUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:M
Other - Last Name:VELASQUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:38642 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-4112
Mailing Address - Country:US
Mailing Address - Phone:813-788-3091
Mailing Address - Fax:352-523-2936
Practice Address - Street 1:12649 HWY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525
Practice Address - Country:US
Practice Address - Phone:352-523-2930
Practice Address - Fax:352-523-2936
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist