MEDICARE: PLAZA DRUGS

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
1	183500000X	Pharmacist	00832	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154534279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA DRUGS

Provider Business Mailing Address
First Line	:	12430 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7608
Country	:	US
Telephone Number	:	409-925-3574
Fax Number	:

Provider Business Practice Location Address
First Line	:	12430 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7608
Country	:	US
Telephone Number	:	409-925-3574
Fax Number	:

Authorized Official
Title or Position	:	OWNER-PHARMACIST
Name	:	DONALD EUGENE HIGGS
Credential	:
Telephone Number	:	409-925-3575

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	06/17/2008

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Directions to “PLAZA DRUGS ” Practice Location

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