Provider Demographics
NPI:1841889227
Name:MARTINEZ-ALVARADO, PAMELA DENISE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:MARTINEZ-ALVARADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9414 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-4106
Mailing Address - Country:US
Mailing Address - Phone:512-837-9580
Mailing Address - Fax:866-569-3047
Practice Address - Street 1:9414 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-4106
Practice Address - Country:US
Practice Address - Phone:512-837-9580
Practice Address - Fax:866-569-3047
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX167361183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician