Provider Demographics
NPI:1619038783
Name:MARTINEZ PHARMACY LC
Entity Type:Organization
Organization Name:MARTINEZ PHARMACY LC
Other - Org Name:MARTINEZ PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PIC
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-722-7600
Mailing Address - Street 1:1407 JACAMAN RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6194
Mailing Address - Country:US
Mailing Address - Phone:956-722-7600
Mailing Address - Fax:956-722-7619
Practice Address - Street 1:1407 JACAMAN RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6194
Practice Address - Country:US
Practice Address - Phone:956-722-7600
Practice Address - Fax:956-722-7619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2023-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X, 3336C0004X
TX225203336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098643OtherPK
TX145287Medicaid
2098643OtherPK