Provider Demographics
NPI:1629470604
Name:MARTINEZ, HERMAN E (PHARMD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:E
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 1:2216 OAKRIDGE DR
Mailing Address - Street 2:APT. 14
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-4525
Mailing Address - Country:US
Mailing Address - Phone:561-685-3512
Mailing Address - Fax:
Practice Address - Street 1:1 KISH HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-756-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-21
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051298096183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist