Provider Demographics
NPI:1902134125
Name:MARTINEZ, CERISSA SHARP (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CERISSA
Middle Name:SHARP
Last Name:MARTINEZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6603 SUMAC PL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79124-4967
Mailing Address - Country:US
Mailing Address - Phone:806-290-0882
Mailing Address - Fax:
Practice Address - Street 1:5709 W AMARILLO BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4003
Practice Address - Country:US
Practice Address - Phone:806-355-7209
Practice Address - Fax:806-355-2971
Is Sole Proprietor?:No
Enumeration Date:2009-11-29
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40836183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist