Organization
LAREDO MEDICAL PLAZA PHARMACY INC
Active
Parent organization
LAREDO MEDICAL PLAZA PHARMACY INC
Other names
Medical Plaza Pharmacy
Organization subpart
Yes
Provider details
NPI number
Legal business name
LAREDO MEDICAL PLAZA PHARMACY INC
Authorized official
GERALD M OLUMBA PHARMD (PIC)
(832) 865-2051
Entity
Organization
Contact information
Practice address
1143 S BUCKNER BLVD STE 121, DALLAS, TX 75217-4304
(214) 914-8601
(214) 915-8556
Mailing address
1143 S BUCKNER BLVD STE 121, DALLAS, TX 75217-4304
(214) 915-8601
(214) 915-8556
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
31133
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146701
—
TX
01
—
2166433
PK
—
Enumeration date
08/28/2012
Last updated
06/12/2024
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