Provider Demographics
NPI:1053994236
Name:MARTINEZ, RENE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
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 1:1300 S BRYAN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6688
Mailing Address - Country:US
Mailing Address - Phone:956-271-4258
Mailing Address - Fax:956-583-2228
Practice Address - Street 1:1300 S BRYAN RD STE 101
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6688
Practice Address - Country:US
Practice Address - Phone:956-271-4258
Practice Address - Fax:956-583-2228
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist