Provider Demographics
NPI:1124013131
Name:MP PHARMACY LLC
Entity Type:Organization
Organization Name:MP PHARMACY LLC
Other - Org Name:MEDPLUS LONG TERM CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SRINIVASU
Authorized Official - Middle Name:
Authorized Official - Last Name:VATTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-868-6420
Mailing Address - Street 1:7220 LOUIS PASTEUR DR
Mailing Address - Street 2:SUITE 152B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-868-6420
Mailing Address - Fax:210-614-8172
Practice Address - Street 1:7220 LOUIS PASTEUR DR
Practice Address - Street 2:SUITE 152B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-868-6420
Practice Address - Fax:210-868-6441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX152123336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100732OtherPK
TX351018Medicaid