1861408338 NPI number — PLAZA PHARMACY, INC

Table of content: (NPI 1861408338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861408338 NPI number — PLAZA PHARMACY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAZA PHARMACY, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861408338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4399 NW 124TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33065-7634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-770-4422
Provider Business Mailing Address Fax Number:
954-728-5505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4399 NW 124TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORAL SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33065-7634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-770-4422
Provider Business Practice Location Address Fax Number:
954-752-8805
Provider Enumeration Date:
08/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CIANCIMINO
Authorized Official First Name:
GIANPAOLO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
877-770-4422

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PH26083 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 1313348 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1861408338 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 184810741 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 65836073 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME16508 . This is a "IDAHO STATE BOARD OF PHARMACY" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 003108720A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3118629 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: MG01127 . This is a "ARKANSAS STATE DME LICENSE" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 1861408338 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1861408338 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 55753 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100138990 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7470001 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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