Provider Demographics
NPI:1598487472
Name:MARTINEZ, HERIBERTO JR (PHARMD)
Entity Type:Individual
Prefix:
First Name:HERIBERTO
Middle Name:
Last Name:MARTINEZ
Suffix:JR
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 1:12159 STONE BARK TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-7331
Mailing Address - Country:US
Mailing Address - Phone:407-462-2442
Mailing Address - Fax:
Practice Address - Street 1:2021 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3035
Practice Address - Country:US
Practice Address - Phone:407-730-3557
Practice Address - Fax:407-730-3560
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43091183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist