Provider Demographics
NPI:1770747370
Name:MARTINEZ, ABRAHAM ANDREW
Entity type:Individual
Prefix:MR
First Name:ABRAHAM
Middle Name:ANDREW
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16780 RENESLAND RD
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-9485
Mailing Address - Country:US
Mailing Address - Phone:913-772-8212
Mailing Address - Fax:
Practice Address - Street 1:16780 RENESLAND RD
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-9485
Practice Address - Country:US
Practice Address - Phone:913-772-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30108183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist