Provider Demographics
NPI:1700888781
Name:LUIS & TERESA MARTINEZ, INC.
Entity Type:Organization
Organization Name:LUIS & TERESA MARTINEZ, INC.
Other - Org Name:MEDCENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:R PH
Authorized Official - Phone:956-791-1991
Mailing Address - Street 1:1419 E BUSTAMANTE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5303
Mailing Address - Country:US
Mailing Address - Phone:956-791-1991
Mailing Address - Fax:956-791-6279
Practice Address - Street 1:1419 E BUSTAMANTE ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5303
Practice Address - Country:US
Practice Address - Phone:956-791-1991
Practice Address - Fax:956-791-6279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23883183500000X
3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX30109OtherPHARMACIST LICENSE
TX145491Medicaid
TXP0139036OtherDPS NO.
TX4598299OtherNABP
TX014351302Medicaid
TX014351301Medicaid
TX23883OtherPHARMACY LICENSE
TX23883OtherPHARMACY LICENSE