Provider Demographics
NPI:1417241589
Name:MARTINEZ, JOSE MANUEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MANUEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AVE FENWAL
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4476
Mailing Address - Country:US
Mailing Address - Phone:787-892-4406
Mailing Address - Fax:
Practice Address - Street 1:10 AVE FENWAL
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4476
Practice Address - Country:US
Practice Address - Phone:787-892-4406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist