Provider Demographics
NPI:1356306633
Name:MARTINEZ, THIRSA (PHARMACIST)
Entity type:Individual
Prefix:
First Name:THIRSA
Middle Name:
Last Name:MARTINEZ
Suffix:
Gender:F
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:CMR 442 BOX 828
Mailing Address - Street 2:(IN THE MILITARY...SORRY THAT'S MY ADDRESS)
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:09042-0828
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 442 BOX 828
Practice Address - Street 2:APO AE 09042
Practice Address - City:HEIDELBERG
Practice Address - State:GERMANY
Practice Address - Zip Code:09042
Practice Address - Country:DE
Practice Address - Phone:01149622-117-2105
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS217771835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy