Provider Demographics
NPI:1912530031
Name:MARTIN, PIERRE C (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:C
Last Name:MARTIN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 LA GOTERA PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-7325
Mailing Address - Country:US
Mailing Address - Phone:281-702-5229
Mailing Address - Fax:
Practice Address - Street 1:201 VINTON RD
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:TX
Practice Address - Zip Code:79821-8811
Practice Address - Country:US
Practice Address - Phone:281-702-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45531183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist