Provider Demographics
NPI:1851057640
Name:MARTINEZ, MANUEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9922 SW 97TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2815
Mailing Address - Country:US
Mailing Address - Phone:305-213-3683
Mailing Address - Fax:
Practice Address - Street 1:9675 NW 117TH AVE # 202
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33178-1228
Practice Address - Country:US
Practice Address - Phone:305-213-3683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46662183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist