Provider Demographics
NPI:1023444387
Name:MARTIS, PEARL MARIA
Entity type:Individual
Prefix:MISS
First Name:PEARL
Middle Name:MARIA
Last Name:MARTIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1025
Mailing Address - Country:US
Mailing Address - Phone:518-496-3130
Mailing Address - Fax:
Practice Address - Street 1:660 COLUMBUS AVENUE
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594
Practice Address - Country:US
Practice Address - Phone:914-769-1834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist