Provider Demographics
NPI:1306567599
Name:MARTINEZ, JOHANNA YVETTE (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:YVETTE
Last Name:MARTINEZ
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 1:2701 N MESA ST # 100A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2543
Mailing Address - Country:US
Mailing Address - Phone:915-444-3423
Mailing Address - Fax:915-444-3424
Practice Address - Street 1:2701 N MESA ST # 100A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2543
Practice Address - Country:US
Practice Address - Phone:915-444-3423
Practice Address - Fax:915-444-3424
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist