1811981848 NPI number — MP PHARMACY LLC

Table of content: (NPI 1811981848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811981848 NPI number — MP PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MP PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
OAKDELL PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811981848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7220 LOUIS PASTEUR
Provider Second Line Business Mailing Address:
SUITE 152
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-868-6440
Provider Business Mailing Address Fax Number:
210-868-6441

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 LOUIS PASTEUR
Provider Second Line Business Practice Location Address:
SUITE 152
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-868-6440
Provider Business Practice Location Address Fax Number:
210-868-6441
Provider Enumeration Date:
09/06/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VATTI
Authorized Official First Name:
SRINIVASU
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
210-868-6440

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 00125 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336C0004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2092563 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148662 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130289 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".