Healthcare Provider Details

I. General information

NPI: 1285790550
Provider Name (Legal Business Name): PLAZA PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30711 UTICA RD
ROSEVILLE MI
48066-1522
US

IV. Provider business mailing address

30711 UTICA RD
ROSEVILLE MI
48066-1522
US

V. Phone/Fax

Practice location:
  • Phone: 586-777-8955
  • Fax: 586-777-8970
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301008552
License Number StateMI

VIII. Authorized Official

Name: MEDHI AL ATRACH
Title or Position: MANAGER
Credential: RPH
Phone: 586-883-2355