Provider Demographics
NPI:1245395177
Name:CRITZ, JOHN MARTIN (PHARMACIST)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MARTIN
Last Name:CRITZ
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 39TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5226
Mailing Address - Country:US
Mailing Address - Phone:727-822-3811
Mailing Address - Fax:
Practice Address - Street 1:8415 BAYSHORE BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33621-1607
Practice Address - Country:US
Practice Address - Phone:813-828-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 12236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist