Provider Demographics
NPI:1639205982
Name:CASTRO, MARTA I (PH)
Entity Type:Individual
Prefix:MRS
First Name:MARTA
Middle Name:I
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 70171
Mailing Address - Street 2:PMB 107
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8171
Mailing Address - Country:US
Mailing Address - Phone:787-731-5302
Mailing Address - Fax:787-765-5937
Practice Address - Street 1:455 AVE PONCE DE LEON
Practice Address - Street 2:ESQ. RUIZ BELVIS, FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917-3711
Practice Address - Country:US
Practice Address - Phone:787-731-5302
Practice Address - Fax:787-765-5937
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2695183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist