Provider Demographics
NPI:1740871045
Name:SANCHEZ, PRIMITIVO JR
Entity type:Individual
Prefix:MR
First Name:PRIMITIVO
Middle Name:
Last Name:SANCHEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:PRIMO
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4444 KOSTORYZ RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78415-5021
Mailing Address - Country:US
Mailing Address - Phone:361-855-6121
Mailing Address - Fax:361-814-8382
Practice Address - Street 1:4444 KOSTORYZ RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78415-5021
Practice Address - Country:US
Practice Address - Phone:361-855-6121
Practice Address - Fax:361-814-8382
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100082183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician