Healthcare Provider Details

I. General information

NPI: 1386749760
Provider Name (Legal Business Name): MLDP OF TEXAS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 BELL LN STE 5A
WEST MONROE LA
71291-6303
US

IV. Provider business mailing address

6601 BLANCO RD SUITE 201
SAN ANTONIO TX
78216-6102
US

V. Phone/Fax

Practice location:
  • Phone: 318-998-3018
  • Fax: 318-998-3020
Mailing address:
  • Phone: 210-510-2692
  • Fax: 210-736-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY005579IR
License Number StateLA

VIII. Authorized Official

Name: DR. ANGELA DIPAOLO
Title or Position: VP OF PHARMACY OPERATIONS
Credential: PHARMD
Phone: 210-510-2692