Provider Demographics
NPI:1356486344
Name:CARLOS G MARTINEZ
Entity Type:Organization
Organization Name:CARLOS G MARTINEZ
Other - Org Name:WARNACK PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DBA
Authorized Official - Phone:559-784-0654
Mailing Address - Street 1:434 S PLANO ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-5416
Mailing Address - Country:US
Mailing Address - Phone:559-784-0654
Mailing Address - Fax:559-784-4712
Practice Address - Street 1:434 S PLANO ST
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-5416
Practice Address - Country:US
Practice Address - Phone:559-784-0654
Practice Address - Fax:559-784-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA280973336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA367050Medicaid
CAPHA367050Medicaid