Provider Demographics
NPI:1588136675
Name:PENALOZA, JOSE MARTIN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARTIN
Last Name:PENALOZA
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12002 BARRYCLIFF CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5447
Mailing Address - Country:US
Mailing Address - Phone:281-773-7533
Mailing Address - Fax:
Practice Address - Street 1:12002 BARRYCLIFF CT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5447
Practice Address - Country:US
Practice Address - Phone:281-773-7533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-30
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPS570381835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy