Provider Demographics
NPI:1699844647
Name:MARTINEZ, JUAN (R PH)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BELISA 1513 CAVALIERI ST.
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-6122
Mailing Address - Country:US
Mailing Address - Phone:787-758-9653
Mailing Address - Fax:787-724-3722
Practice Address - Street 1:FARMACIA LUIS P R #4 INC
Practice Address - Street 2:1501 PONCE DE LEON AVE
Practice Address - City:SAN JUAN,
Practice Address - State:PR
Practice Address - Zip Code:00909-1779
Practice Address - Country:US
Practice Address - Phone:787-722-1590
Practice Address - Fax:787-724-3722
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist