Provider Demographics
NPI:1831748334
Name:SAENZ MEDICAL PHARMACY OF PENITAS, INC.
Entity type:Organization
Organization Name:SAENZ MEDICAL PHARMACY OF PENITAS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
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:956-585-2704
Mailing Address - Street 1:PO BOX 214
Mailing Address - Street 2:
Mailing Address - City:PENITAS
Mailing Address - State:TX
Mailing Address - Zip Code:78576-0214
Mailing Address - Country:US
Mailing Address - Phone:956-585-2704
Mailing Address - Fax:956-585-3411
Practice Address - Street 1:1000 E EXPRESSWAY 83 STE 1
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-8304
Practice Address - Country:US
Practice Address - Phone:956-585-2704
Practice Address - Fax:956-585-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-06
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11088401Medicaid
TX144296Medicaid
TX148231Medicaid