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NPI Code Detail

MEDICARE: MEDICAL PLAZA PHARMACY, INC.

MEDICARE: MEDICAL PLAZA PHARMACY, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1333600000XPharmacy6075676-1703UT
2333600000XPharmacy9120628-1703UT

General Provider Information

NPI Number : 1003897356
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL PLAZA PHARMACY, INC.
Provider Business Mailing Address
First Line : 1060 E 100 S
Second Line : SUITE L-2
City : SALT LAKE CITY
State : UT
Zip : 84102-1501
Country : US
Telephone Number : 801-539-0231
Fax Number : 801-539-0350
Provider Business Practice Location Address
First Line : 1060 E 100 S
Second Line : SUITE L-2
City : SALT LAKE CITY
State : UT
Zip : 84102-1501
Country : US
Telephone Number : 801-539-0231
Fax Number : 801-539-0350
Authorized Official
Title or Position : CEO
Name : MR. TODD SONDRUP
Credential : R.PH.
Telephone Number : 801-539-0231
Provider Enumeration Date : 11/11/2005
Last Update Date : 10/30/2014

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Directions to “MEDICAL PLAZA PHARMACY, INC. ” Practice Location

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