Provider Demographics
NPI:1790013415
Name:MARTINEZ, VIRNA L (RPH)
Entity Type:Individual
Prefix:MRS
First Name:VIRNA
Middle Name:L
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 5 BOX 92552
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9549
Mailing Address - Country:US
Mailing Address - Phone:787-429-3997
Mailing Address - Fax:787-262-6227
Practice Address - Street 1:ROAD 130 KM 11.3 BO CAMPO ALEGRE
Practice Address - Street 2:
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-0000
Practice Address - Country:US
Practice Address - Phone:787-898-8616
Practice Address - Fax:787-262-6227
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-19
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4388183500000X
PR333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy