NPIMap

Organization Active NPI

MLDP of Texas LP

  • Long Term Care Pharmacy
  • San Antonio, TX
National Provider Identifier
1538235643
Registry record updated Mar 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
24014 Issued in TX
Legal business name
MLDP OF TEXAS LP
Doing business as
LEGENDS PHARMACY
Practice address
6601 Blanco Rd Ste 250
San Antonio, TX 78216-6105
Phone
(210) 434-2477
Fax
(855) 298-6576
NPI assigned
Nov 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2025

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

Authorized official

Name
Angela Dipaolo, PHARM D
Title
VP of Pharmacy Operations
Phone
(210) 510-2692

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X 24014 TX Primary

Addresses

Primary practice location

6601 Blanco Rd Ste 250
San Antonio, TX 78216-6105

Mailing address

6601 Blanco Rd
Suite 201
San Antonio, TX 78216-6102
Phone (210) 510-2692

Other identifiers 2

IdentifierTypeStateIssuer
350197MedicaidTX
2097650OtherPK

Other names 1

  • LEGENDS PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190919000369 TX Part B Supplier - Mass Immunization (Roster Biller Only) 0547590457 1 other NPI on this enrollment
Practice locations: San Antonio, TX

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Legends Pharmacy2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6601 Blanco Rd
Ste 250
San Antonio, TX 78216
Phone (210) 434-2477

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743292800000",
    "number": "1538235643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 BLANCO RD",
            "address_2": "SUITE 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782166102",
            "telephone_number": "210-510-2692",
            "fax_number": "210-736-4438"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 BLANCO RD STE 250",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782166105",
            "telephone_number": "210-434-2477",
            "fax_number": "855-298-6576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MLDP OF TEXAS LP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2025-03-30",
        "certification_date": "2025-03-30",
        "status": "A",
        "authorized_official_last_name": "DIPAOLO",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "VP OF PHARMACY OPERATIONS",
        "authorized_official_telephone_number": "210-510-2692",
        "authorized_official_credential": "PHARM D"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "24014",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350197",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2097650",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LEGENDS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.