Provider Demographics
NPI:1659465342
Name:MARTINEZ DRUG STORE, INC.
Entity Type:Organization
Organization Name:MARTINEZ DRUG STORE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-693-0441
Mailing Address - Street 1:874 E 41 STREET
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013
Mailing Address - Country:US
Mailing Address - Phone:305-693-0441
Mailing Address - Fax:305-693-0680
Practice Address - Street 1:874 E 41 STREET
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013
Practice Address - Country:US
Practice Address - Phone:305-693-0441
Practice Address - Fax:305-693-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS162943336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10286201Medicaid
FL4485490001Medicare ID - Type UnspecifiedREGION C