Provider Demographics
NPI:1184688921
Name:YODOR INC.
Entity Type:Organization
Organization Name:YODOR INC.
Other - Org Name:MISSION PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, SECRETARY, PHARMACIST
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:
Authorized Official - Phone:956-581-8833
Mailing Address - Street 1:1611 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-4529
Mailing Address - Country:US
Mailing Address - Phone:956-581-8833
Mailing Address - Fax:956-581-0364
Practice Address - Street 1:906 S BRYAN RD STE 101A
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6605
Practice Address - Country:US
Practice Address - Phone:956-581-8833
Practice Address - Fax:956-581-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15042183500000X
TX148627332B00000X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes333600000XSuppliersPharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX013987503Medicaid
TX333600000XOtherTAXONOMY PHARMACY
TX013987502Medicaid
TX183500000XOtherPHARMACIST
TX148627Medicaid
TX0818070001OtherCMS
TX332B00000XOtherTAXONOMY DME
TX4581547OtherNABP
TXBY3278036OtherDEA
TX0818070001OtherCMS