Provider Demographics
NPI:1497889901
Name:MARTINEZ, BRENDA SUE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:SUE
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 BLAZING STAR DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-4867
Mailing Address - Country:US
Mailing Address - Phone:512-863-3320
Mailing Address - Fax:
Practice Address - Street 1:5510 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2620
Practice Address - Country:US
Practice Address - Phone:847-588-7170
Practice Address - Fax:847-588-7080
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41095183500000X
AR05308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK05308OtherPHARMACY LICENSE NUMBER
TX41095OtherPHARMACY LICENSE NUMBER