1356306633 NPI number — THIRSA MARTINEZ PHARMACIST

Table of content: THIRSA MARTINEZ PHARMACIST (NPI 1356306633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356306633 NPI number — THIRSA MARTINEZ PHARMACIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTINEZ
Provider First Name:
THIRSA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMACIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356306633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 442 BOX 828
Provider Second Line Business Mailing Address:
(IN THE MILITARY...SORRY THAT'S MY ADDRESS)
Provider Business Mailing Address City Name:
NY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
09042-0828
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CMR 442 BOX 828
Provider Second Line Business Practice Location Address:
APO AE 09042
Provider Business Practice Location Address City Name:
HEIDELBERG
Provider Business Practice Location Address State Name:
GERMANY
Provider Business Practice Location Address Postal Code:
09042
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011496221172105
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PS21777 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)