Healthcare Provider Details

I. General information

NPI: 1720537251
Provider Name (Legal Business Name): PLAZA DRUG OF LONDON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N LAUREL RD
LONDON KY
40741-6025
US

IV. Provider business mailing address

PO BOX 202
PITTSBURG KY
40755-0202
US

V. Phone/Fax

Practice location:
  • Phone: 606-657-5245
  • Fax: 606-657-5382
Mailing address:
  • Phone: 606-657-5245
  • Fax: 606-657-5382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberP07655
License Number StateKY

VIII. Authorized Official

Name: MIKE SIZEMORE
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 606-657-5245