Provider Demographics
NPI:1306973532
Name:SAENZ MEDICAL PHARMACY AT
Entity type:Organization
Organization Name:SAENZ MEDICAL PHARMACY AT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, AO
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:SAENZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-618-4500
Mailing Address - Street 1:2821 MICHAELANGELO DR
Mailing Address - Street 2:STE 103
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-1404
Mailing Address - Country:US
Mailing Address - Phone:956-618-4500
Mailing Address - Fax:956-687-5531
Practice Address - Street 1:2821 MICHAELANGELO DR
Practice Address - Street 2:STE 103
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1404
Practice Address - Country:US
Practice Address - Phone:956-618-4500
Practice Address - Fax:956-687-5531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX243883336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2098751OtherPK
TX145625Medicaid
6187220001Medicare NSC