Provider Demographics
NPI:1245517861
Name:MARTINEZ, TAMMY ANN (RPH)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
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 1:5721 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-1868
Mailing Address - Country:US
Mailing Address - Phone:505-216-1492
Mailing Address - Fax:
Practice Address - Street 1:6605 4TH ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6112
Practice Address - Country:US
Practice Address - Phone:505-345-9059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00006012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist