Most Relevant Information
Provider Data
| NPI Number: | 1003335852 |
| Provider Name: | MARTHA ELIZABETH SO HUERTA |
| Entity Type: | Individual |
| Taxonomy Code: | 183500000X |
| Specialty: | Pharmacist |
| License Number: | 123570 |
Most Important Dates
| Enumeration Date: | 09/13/2017 |
| Last Updated: | 09/13/2017 |
Provider Practice Location
3620 TEXAS AVE S
ST LOUIS PARK
MN
554264057
Practice Location Phone/Fax
| Phone: | 9529333177 |
| Fax: |
Provider Mailing Location
3620 TEXAS AVE S
ST LOUIS PARK
MN
554264057
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |