Provider Demographics
NPI:1891057782
Name:MARTINEZ, MARCIAL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCIAL
Middle Name:
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 1:1956 HIGHWAY 180 E
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7781
Mailing Address - Country:US
Mailing Address - Phone:575-388-0133
Mailing Address - Fax:
Practice Address - Street 1:1956 HIGHWAY 180 E
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7781
Practice Address - Country:US
Practice Address - Phone:575-388-0133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00007822183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist