Provider Demographics
NPI:1396126892
Name:MARTINO, LESA MARIA (PHARMD)
Entity type:Individual
Prefix:
First Name:LESA
Middle Name:MARIA
Last Name:MARTINO
Suffix:
Gender:F
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:PO BOX 320174
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33679-2174
Mailing Address - Country:US
Mailing Address - Phone:813-335-6404
Mailing Address - Fax:
Practice Address - Street 1:235 W BRANDON BLVD
Practice Address - Street 2:#267
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5103
Practice Address - Country:US
Practice Address - Phone:813-335-6404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24343183500000X
TX52070183500000X
NC13385183500000X
MSE7847183500000X
FLPU3524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist