Provider Demographics
NPI:1740162759
Name:MARTINEZ, GUADALUPE TOMAS
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:TOMAS
Last Name:MARTINEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 N WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-3856
Mailing Address - Country:US
Mailing Address - Phone:361-227-2659
Mailing Address - Fax:
Practice Address - Street 1:5326 E US HIGHWAY 83 STE A-5
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9409
Practice Address - Country:US
Practice Address - Phone:956-317-1112
Practice Address - Fax:956-317-1113
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist