Laredo Medical Plaza Pharmacy Inc

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

31133 Issued in TX

Legal business name

LAREDO MEDICAL PLAZA PHARMACY INC

Doing business as

Medical Plaza Pharmacy

Practice address

1143 S Buckner Blvd Ste 121
Dallas, TX 75217-4304

Phone

(214) 914-8601

Fax

(214) 915-8556

NPI assigned

Aug 28, 2012

Last updated

Jun 12, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

LAREDO MEDICAL PLAZA PHARMACY INCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gerald M Olumba, PHARMD

Title

Pic

Phone

(832) 865-2051

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Medical Plaza Pharmacy Doing business as

Part of

Laredo Medical Plaza Pharmacy Inc

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1518215276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1143 S BUCKNER BLVD STE 121",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752174304",
            "telephone_number": "214-915-8601",
            "fax_number": "214-915-8556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1143 S BUCKNER BLVD STE 121",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752174304",
            "telephone_number": "214-914-8601",
            "fax_number": "214-915-8556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAREDO MEDICAL PLAZA PHARMACY INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAREDO MEDICAL PLAZA PHARMACY INC",
        "enumeration_date": "2012-08-28",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "OLUMBA",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PIC",
        "authorized_official_telephone_number": "832-865-2051",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "31133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2166433",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "146701",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Plaza Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Eric Lara, CRNA
• Mallory Anne Lara, MD
• Stephen Jerome Larash, DDS
• Charles Marcellus Larbie
• Ashley Anne Larche, LPC
• Jessica Dawn Large, FNP-C
• Patricia Larios, M.D.
• Gregory Steven Lark
• Kimberly Larkin
• Sharon Kay Larkin, LPC-A

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.