MEDICARE: PLAZA DRUG CO. 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
1	333600000X	Pharmacy	0062101.1	MS

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	:	1982689956
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLAZA DRUG CO. INC.

Provider Business Mailing Address
First Line	:	545 E MAIN ST
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-3005
Country	:	US
Telephone Number	:	662-494-2535
Fax Number	:	662-494-2200

Provider Business Practice Location Address
First Line	:	545 E MAIN ST
Second Line	:
City	:	WEST POINT
State	:	MS
Zip	:	39773-3005
Country	:	US
Telephone Number	:	662-494-2535
Fax Number	:	662-494-2200

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN COLON JOHNSON
Credential	:	R. PH.
Telephone Number	:	662-494-2535

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	07/21/2022

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