Provider Demographics
NPI:1720557234
Name:MARTIN, VIVIANNA R (PHARMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:VIVIANNA
Middle Name:R
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHARMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 E GONZALES RD FL 1
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0619
Mailing Address - Country:US
Mailing Address - Phone:805-278-5950
Mailing Address - Fax:805-278-5913
Practice Address - Street 1:2200 E GONZALES RD FL 1
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0619
Practice Address - Country:US
Practice Address - Phone:805-278-5950
Practice Address - Fax:805-278-5913
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2024-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH84878183500000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist