Provider Demographics
NPI:1518215276
Name:LAREDO MEDICAL PLAZA PHARMACY INC
Entity Type:Organization
Organization Name:LAREDO MEDICAL PLAZA PHARMACY INC
Other - Org Name:MEDICAL PLAZA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-718-2770
Mailing Address - Street 1:10710 MCPHERSON RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6363
Mailing Address - Country:US
Mailing Address - Phone:956-718-2770
Mailing Address - Fax:956-718-2786
Practice Address - Street 1:10710 MCPHERSON RD STE 102
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-718-2770
Practice Address - Fax:956-718-2786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX311333336C0003X
TX283433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX146701Medicaid
2166433OtherPK