Provider Demographics
NPI:1710498589
Name:MARTINEZ, BRANDON KYLE (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:KYLE
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 1:200 ANDREWS WAY APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-6995
Mailing Address - Country:US
Mailing Address - Phone:480-710-4324
Mailing Address - Fax:
Practice Address - Street 1:200 ANDREWS WAY APT 206
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-6995
Practice Address - Country:US
Practice Address - Phone:480-710-4324
Practice Address - Fax:480-710-4324
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0216411835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist