Provider Demographics
NPI:1578103610
Name:MARTINEZ, YOLANDA (RPH)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1291
Mailing Address - Street 2:
Mailing Address - City:BOQUERON
Mailing Address - State:PR
Mailing Address - Zip Code:00622-1291
Mailing Address - Country:US
Mailing Address - Phone:787-464-1660
Mailing Address - Fax:
Practice Address - Street 1:3301 ROUTE KM 2.0
Practice Address - Street 2:HOUSE SECOND FLOOR- PHARMACY EL COMBATE
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-464-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3274183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist