Provider Demographics
NPI:1326115510
Name:CENTENO, MARTA SOSA (RPH)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:SOSA
Last Name:CENTENO
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 1:146 WINDSOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-3163
Mailing Address - Country:US
Mailing Address - Phone:210-313-3624
Mailing Address - Fax:
Practice Address - Street 1:138 SW MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-1612
Practice Address - Country:US
Practice Address - Phone:210-927-6052
Practice Address - Fax:210-927-6212
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28680183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist