Provider Demographics
NPI:1265096580
Name:MARTINEZ, LUIS JR (RPH)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:
Last Name:MARTINEZ
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist