Provider Demographics
NPI:1093718025
Name:YODORINCMISSIONPLAZAPHARMACY
Entity Type:Organization
Organization Name:YODORINCMISSIONPLAZAPHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VPSECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:956-583-0044
Mailing Address - Street 1:906 S BRYAN RD
Mailing Address - Street 2:STE 101A
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6657
Mailing Address - Country:US
Mailing Address - Phone:956-581-8833
Mailing Address - Fax:
Practice Address - Street 1:RR 8 BOX 3311
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-8606
Practice Address - Country:US
Practice Address - Phone:956-583-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX016974001Medicaid
TX130056804Medicaid
TX130056804Medicaid