Provider Demographics
NPI:1245889757
Name:SAENZ MEDICAL PHARMACY LONE STAR, INC.
Entity type:Organization
Organization Name:SAENZ MEDICAL PHARMACY LONE STAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:SAENZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-630-6465
Mailing Address - Street 1:2121 E GRIFFIN PKWY STE 18
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3072
Mailing Address - Country:US
Mailing Address - Phone:956-519-6500
Mailing Address - Fax:956-519-6524
Practice Address - Street 1:2121 E GRIFFIN PKWY STE 18
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3072
Practice Address - Country:US
Practice Address - Phone:956-519-6500
Practice Address - Fax:956-519-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167743701Medicaid
TX145376Medicaid
TX148229Medicaid