Provider Demographics
NPI:1619963758
Name:MARTINEZ, GLENN ERIC (BS PHARM, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ERIC
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:BS PHARM, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 BECKLEY PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-1030
Mailing Address - Country:US
Mailing Address - Phone:636-577-7369
Mailing Address - Fax:
Practice Address - Street 1:JOHN COCHRAN VA MEDICAL CENTER
Practice Address - Street 2:915 NORTH GRAND
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106
Practice Address - Country:US
Practice Address - Phone:314-289-6339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 39822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist