Organization
MLDP OF TEXAS LP
Active
Other names
LEGENDS PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA DIPAOLO PHARMD (VP OF PHARMACY OPERATIONS)
(210) 510-2692
Entity
Organization
Contact information
Practice address
222 BELL LN STE 5A, WEST MONROE, LA 71291-6303
(318) 998-3018
(318) 998-3020
Mailing address
6601 BLANCO RD, SUITE 201, SAN ANTONIO, TX 78216-6102
(210) 510-2692
(210) 736-4438
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY005579IR
LA
3336L0003X
Long Term Care Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1210706
—
LA
01
—
2035341
PK
—
Enumeration date
09/13/2006
Last updated
03/05/2024
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