Provider Demographics
NPI:1134732159
Name:MARTINEZ, RICARDO DANIEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:DANIEL
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 PUERTA DEL SOL DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4246
Mailing Address - Country:US
Mailing Address - Phone:956-334-3306
Mailing Address - Fax:
Practice Address - Street 1:4602 N BARTLETT AVE
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3803
Practice Address - Country:US
Practice Address - Phone:956-523-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63215183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist