Healthcare Provider Details

I. General information

NPI: 1861408338
Provider Name (Legal Business Name): PLAZA PHARMACY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4399 NW 124TH AVE
CORAL SPRINGS FL
33065-7634
US

IV. Provider business mailing address

4399 NW 124TH AVE
CORAL SPRINGS FL
33065-7634
US

V. Phone/Fax

Practice location:
  • Phone: 877-770-4422
  • Fax: 954-752-8805
Mailing address:
  • Phone: 877-770-4422
  • Fax: 954-728-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1313348
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26083
License Number StateFL

VIII. Authorized Official

Name: MR. GIANPAOLO CIANCIMINO
Title or Position: OWNER
Credential:
Phone: 877-770-4422