Provider Demographics
NPI:1023657962
Name:MARTINOVICH, PATRICIA PETROSLAVA (RPH)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:PETROSLAVA
Last Name:MARTINOVICH
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-3010
Mailing Address - Country:US
Mailing Address - Phone:941-451-8292
Mailing Address - Fax:
Practice Address - Street 1:17000 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7281
Practice Address - Country:US
Practice Address - Phone:941-423-8336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46911183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist